Grievances & Appeals Representative
or drop it." The intro "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..." This is basically the job description summary. We can keep as
under maybe About the role? Actually "About the role" heading is appropriate for that summary. We'll put that content under
About the role
with. Responsibilities: list bullet points from "Key Responsibilities". We'll extract each line. Requirements: "Required Qualifications" list bullet points. Qualifications: "Preferred Qualifications" list bullet points. Skills: maybe combine required/preferred? But we have separate sections: Skills maybe we can include Microsoft systems etc. However we already have Required Qualifications includes skills. Could create a Skills section for "Ability to manage large volume on inventory daily" etc. But we can also keep under Requirements. The instruction: Prefer a few substantive sections over many thin ones. So we might combine Required and Preferred into Requirements and Qualifications? Actually they said use headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we need to map content accordingly. We have: - About the role: summary paragraph. - Responsibilities: bullet list of key responsibilities. - Requirements: maybe "Minimum of 1 year of customer service experience..." etc. That's required qualifications. - Qualifications: maybe "Preferred Qualifications" list. - Skills: maybe "Ability to manage large volume on inventory daily" etc. But that's also a requirement. Could put under Skills: "Strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.)", "Ability to manage large volume on inventory daily". However we already have those in Required Qualifications. To avoid duplication, we could put those under Skills and keep Requirements as just the years of experience? But we must preserve ALL substantive information; we cannot omit. So we need to include all info somewhere. We can split: Requirements: years of experience and production-driven environment. Qualifications: preferred qualifications. Skills: Microsoft systems, ability to manage large volume, etc. But we need to ensure not duplicate. Let's decide: Requirements (hard minimums): - Minimum of 1 year of customer service experience - Minimum of 1 year of data entry experience - Experience in a production-driven environment Skills: - Strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.) - Ability to manage large volume on inventory daily Qualifications (preferred): - 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 Benefits: description of benefits paragraph. Pay: pay range $40,000 - $52,300 per year. Schedule: workstyle remote, work location CST/EST, training schedule Monday-Friday 8am-4:30pm EST, shift after training Wednesday-Sunday schedule with details. Also include other details like 18-month commitment, work at home requirements, travel, etc. Those are not covered by headings but we need to preserve ALL substantive information. Where to put? Could be under About the role or maybe a separate section like "Additional Information". But we only allowed headings list; we cannot add extra headings not in list unless they have real content. The instruction: "include a section ONLY when the posting has real, specific content for it — never emit a heading followed by filler/placeholder text". It doesn't forbid adding other headings beyond the list, but they gave a list of possible headings to use. It says "Use
for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." The "e.g." suggests those are examples, not exclusive. However they also say "Prefer a few substantive sections over many thin ones." So we could add an "Additional Information" section for the extra details (18-month commitment, work at home requirements, travel). That seems reasonable.
We must not include boilerplate like EEO etc. Remove that.
We must not include duplicated lines.
We must not include application instructions.
We must not include cookie/navigation/legal etc.
Thus final HTML will have sections: About the role, Responsibilities, Requirements, Skills, Qualifications, Benefits, Pay, Schedule, Additional Information.
Check each for real content.
Now craft HTML.
We'll output:
About the role
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.
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.
Requirements
- Minimum of 1 year of customer service experience
- Minimum of 1 year of data entry experience
- Experience in a production-driven environment
Skills
- Strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.)
- Ability to manage large volume on inventory daily
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
Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
Pay
$40,000 - $52,300 per year
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.
Additional 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.
- 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.