Grievances & Appeals Representative
for section headings. Use - for any list of duties/requirements/benefits. Use
for prose.
We need to decide what constitutes a list. Responsibilities are bullet points? In text they are sentences separated by periods but each starts with a verb. We can treat as list. Similarly Required Qualifications and Preferred Qualifications can be lists. Benefits also list.
We need to preserve details: For responsibilities: "Assign cases to team members for submission to an independent entity for 2nd level review." etc. We'll capture each sentence as list item.
Required Qualifications: list items: Minimum of 1 year of customer service experience; Minimum of 1 year of data entry experience; Experience in a production-driven environment; Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.); Ability to manage large volume on inventory daily.
Preferred Qualifications: list items: Previous inbound call center or related customer service experience; Previous grievance and appeals experience; Medical terminology experience; Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish; Prior experience with Medicare.
Additional Information: includes Workstyle: remote, work from home; Work Location: must reside in Central or Eastern Standard Time Zone (CST or EST); Training schedule: Monday-Friday, 8am-4:30pm EST; Shift after training: Wednesday-Sunday schedule. The Wednesday-Friday shifts are 9am-5:30pm EST The Saturday-Sunday shifts are 8am-4:30pm EST; Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18-months.; Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.; Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.; Scheduled Weekly Hours 40; Pay Range: $40,000 - $52,300 per year; Description Of Benefits: list of benefits; About Us: paragraph.
We need to decide sections: About the role (initial paragraph). Responsibilities (list). Required Qualifications (list). Preferred Qualifications (list). Work Schedule (maybe combine training schedule, shift after training, scheduled weekly hours). Could be "Schedule". Pay (Pay Range). Benefits (Description Of Benefits). About Us (About Humana). Possibly also "Work Location" etc could be under "Schedule" or separate "Work Details". But instruction: prefer a few substantive sections over many thin ones. Could combine location, workstyle, travel, etc under "Work Details". But we have headings list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. They gave examples but not mandatory to use only those; we can use others if needed but better to stick to those. However we have both Required Qualifications and Preferred Qualifications; could combine under "Qualifications". But we have separate headings for Required and Preferred? The examples include "Qualifications". Could have a single "Qualifications" section with subheadings? But we cannot use headings other than h3? We could still use
for Qualifications and then inside have
with both required and preferred? But they said use
- for any list of duties/requirements/benefits. So we could have a single Qualifications section with two lists: Required Qualifications and Preferred Qualifications as subheadings? But subheadings would be maybe
not allowed? Not specified. Safer to keep separate sections: Required Qualifications and Preferred Qualifications as separate headings (both h3). That's okay.
Similarly Benefits as its own section.
Schedule: we have training schedule, shift after training, scheduled weekly hours. Could be under Schedule.
Pay: Pay Range.
About Us: maybe not in list but we can have About Us section.
We must not include Equal Opportunity Employer.
Now produce HTML fragment.
Let's craft:
About the role
Become a part of our caring community Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials. You will perform thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified. Then, you will provide final determinations utilizing your expertise and collaboration with clinical and other Humana teams. Your contributions will directly support Humana's commitment to delivering high-quality service and making a positive difference in the lives of those we serve. Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Note: The sentence repeats "Become a part of our caring community Become a valued member". Might be a duplication but we keep as is.
Responsibilities
- Assign cases to team members for submission to an independent entity for 2nd level review.
- Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates.
- Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision.
- Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment.
Required Qualifications
- Minimum of 1 year of customer service experience
- Minimum of 1 year of data entry experience
- Experience in a production-driven environment
- Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.)
- Ability to manage large volume on inventory daily
Preferred Qualifications
- Previous inbound call center or related customer service experience
- Previous grievance and appeals experience
- Medical terminology experience
- Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
- Prior experience with Medicare
Schedule
Workstyle: remote, work from home
Work Location: must reside in Central or Eastern Standard Time Zone (CST or EST)
Training schedule: Monday-Friday, 8am-4:30pm EST
Shift after training: Wednesday-Sunday schedule. The Wednesday-Friday shifts are 9am-5:30pm EST. The Saturday-Sunday shifts are 8am-4:30pm EST.
Scheduled Weekly Hours: 40
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18-months.
Pay
$40,000 - $52,300 per year
Benefits
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Many other opportunities
About Us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
We must ensure no extra boilerplate. Also we should not include any markdown fences. Just plain HTML.
Check for any duplicated lines: we kept the initial paragraph as is; it had duplicate phrase "Become a part of our caring community Become a valued member". That's from posting; we keep.
Check for any mention of EEO etc: we removed.
Check for any mention of cookie/navigation etc: none.
Check for any mention of "Equal Opportunity Employer": removed.
Check for any mention of "Additional Information": we incorporated its content into Schedule section; we didn't keep a heading "Additional Information". That's fine.
Check for any mention of "Workstyle", "Work Location", etc: we kept as paragraphs under Schedule.
Check for any mention of "Scheduled Weekly Hours 40": we have.
Check for any mention of "Pay Range": we have.
for prose. We need to decide what constitutes a list. Responsibilities are bullet points? In text they are sentences separated by periods but each starts with a verb. We can treat as list. Similarly Required Qualifications and Preferred Qualifications can be lists. Benefits also list. We need to preserve details: For responsibilities: "Assign cases to team members for submission to an independent entity for 2nd level review." etc. We'll capture each sentence as list item. Required Qualifications: list items: Minimum of 1 year of customer service experience; Minimum of 1 year of data entry experience; Experience in a production-driven environment; Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.); Ability to manage large volume on inventory daily. Preferred Qualifications: list items: Previous inbound call center or related customer service experience; Previous grievance and appeals experience; Medical terminology experience; Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish; Prior experience with Medicare. Additional Information: includes Workstyle: remote, work from home; Work Location: must reside in Central or Eastern Standard Time Zone (CST or EST); Training schedule: Monday-Friday, 8am-4:30pm EST; Shift after training: Wednesday-Sunday schedule. The Wednesday-Friday shifts are 9am-5:30pm EST The Saturday-Sunday shifts are 8am-4:30pm EST; Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18-months.; Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.; Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.; Scheduled Weekly Hours 40; Pay Range: $40,000 - $52,300 per year; Description Of Benefits: list of benefits; About Us: paragraph. We need to decide sections: About the role (initial paragraph). Responsibilities (list). Required Qualifications (list). Preferred Qualifications (list). Work Schedule (maybe combine training schedule, shift after training, scheduled weekly hours). Could be "Schedule". Pay (Pay Range). Benefits (Description Of Benefits). About Us (About Humana). Possibly also "Work Location" etc could be under "Schedule" or separate "Work Details". But instruction: prefer a few substantive sections over many thin ones. Could combine location, workstyle, travel, etc under "Work Details". But we have headings list: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. They gave examples but not mandatory to use only those; we can use others if needed but better to stick to those. However we have both Required Qualifications and Preferred Qualifications; could combine under "Qualifications". But we have separate headings for Required and Preferred? The examples include "Qualifications". Could have a single "Qualifications" section with subheadings? But we cannot use headings other than h3? We could still use
for Qualifications and then inside have
with both required and preferred? But they said use
- for any list of duties/requirements/benefits. So we could have a single Qualifications section with two lists: Required Qualifications and Preferred Qualifications as subheadings? But subheadings would be maybe
not allowed? Not specified. Safer to keep separate sections: Required Qualifications and Preferred Qualifications as separate headings (both h3). That's okay. Similarly Benefits as its own section. Schedule: we have training schedule, shift after training, scheduled weekly hours. Could be under Schedule. Pay: Pay Range. About Us: maybe not in list but we can have About Us section. We must not include Equal Opportunity Employer. Now produce HTML fragment. Let's craft:
About the role
Become a part of our caring community Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials. You will perform thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified. Then, you will provide final determinations utilizing your expertise and collaboration with clinical and other Humana teams. Your contributions will directly support Humana's commitment to delivering high-quality service and making a positive difference in the lives of those we serve. Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Note: The sentence repeats "Become a part of our caring community Become a valued member". Might be a duplication but we keep as is.Responsibilities
- Assign cases to team members for submission to an independent entity for 2nd level review.
- Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates.
- Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision.
- Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment.
Required Qualifications
- Minimum of 1 year of customer service experience
- Minimum of 1 year of data entry experience
- Experience in a production-driven environment
- Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.)
- Ability to manage large volume on inventory daily
Preferred Qualifications
- Previous inbound call center or related customer service experience
- Previous grievance and appeals experience
- Medical terminology experience
- Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
- Prior experience with Medicare
Schedule
Workstyle: remote, work from home
Work Location: must reside in Central or Eastern Standard Time Zone (CST or EST)
Training schedule: Monday-Friday, 8am-4:30pm EST
Shift after training: Wednesday-Sunday schedule. The Wednesday-Friday shifts are 9am-5:30pm EST. The Saturday-Sunday shifts are 8am-4:30pm EST.
Scheduled Weekly Hours: 40
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18-months.
Pay
$40,000 - $52,300 per year
Benefits
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Many other opportunities
About Us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
We must ensure no extra boilerplate. Also we should not include any markdown fences. Just plain HTML. Check for any duplicated lines: we kept the initial paragraph as is; it had duplicate phrase "Become a part of our caring community Become a valued member". That's from posting; we keep. Check for any mention of EEO etc: we removed. Check for any mention of cookie/navigation etc: none. Check for any mention of "Equal Opportunity Employer": removed. Check for any mention of "Additional Information": we incorporated its content into Schedule section; we didn't keep a heading "Additional Information". That's fine. Check for any mention of "Workstyle", "Work Location", etc: we kept as paragraphs under Schedule. Check for any mention of "Scheduled Weekly Hours 40": we have. Check for any mention of "Pay Range": we have.