Grievances & Appeals Representative

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.

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