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Job Details

Grievances and Appeals Representative 4 - Work at Home/Remote CST/EST

Company name
Humana Inc.

Jersey City, NJ, United States

Employment Type

Operations, Work At Home, Customer Service

Posted on
Aug 23, 2021

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The Grievances & Appeals Representative 4 assists members, via phone or face to face, further/support quality related goals. Reviews the level 1 appeals cases and ensures that information is correct and then forwards to CMS entity for further review. Investigates and resolves member and practitioner issues.

Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and is the primary administrative owner of a main process, program, product or technology.

Works within broad guidelines with little oversight.

Required Qualifications

Must be able to work an 8 hour shift. (Start time can be between 8 am and 9 am EST)

Weekends required on rotating basis (also some holidays as needed)

Strong data entry skills required

1-3 years of customer service experience

Strong proficiency with Microsoft Word and Excel

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Associate's or Bachelor's Degree

Experience with electronic inventory management - able to complete assigned cases in a specified time frame.

Experience in a production driven environment

Previous inbound call center or related customer service experience

2 - 4 years of grievance and appeals experience

CAS, PAHub and MedHOK experience strongly preferred

Previous experience processing medical claims

Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish

Additional Information

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours


Company info

Humana Inc.
Website :

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