Grievance & Appeals Representative

Are you a passionate and empathetic individual looking for a meaningful career? Do you have experience in handling complex customer complaints and resolving issues? If so, then we want you to join our team as a Grievance & Appeals Representative at Humana.In this role, you will be responsible for managing and resolving member grievances and appeals in a timely and efficient manner. You will work closely with our members, providers, and internal teams to ensure that all concerns and issues are addressed and resolved to the satisfaction of all parties involved.To excel in this position, you must possess excellent communication and problem-solving skills, as well as the ability to remain calm and professional in high-stress situations. A strong understanding of healthcare policies and regulations is also required.If you are passionate about making a positive impact in the lives of others and have the necessary qualifications, we invite you to apply for this rewarding opportunity at Humana.

1. Manage and resolve member grievances and appeals in a timely and efficient manner.
2. Communicate with members, providers, and internal teams to understand and address concerns and issues.
3. Ensure that all grievances and appeals are handled according to established policies and procedures.
4. Maintain accurate documentation of all grievance and appeal cases.
5. Collaborate with other departments to identify and address recurring issues and implement solutions.
6. Stay up-to-date on healthcare policies and regulations to ensure compliance in all grievance and appeal processes.
7. Provide excellent customer service by demonstrating empathy, active listening, and effective problem-solving skills.
8. Remain calm and professional in high-stress situations, demonstrating strong emotional intelligence.
9. Advocate for members and work towards a resolution that meets their needs and expectations.
10. Identify opportunities for process improvement and make recommendations to management.
11. Handle confidential information with discretion and maintain strict confidentiality at all times.
12. Meet performance goals and targets set by the company.
13. Attend training sessions and meetings to continuously improve skills and knowledge.
14. Adhere to all ethical and professional standards of conduct.
15. Perform other duties as assigned by the supervisor.

According to JobzMall, the average salary range for a Grievance & Appeals Representative in Louisville, KY, USA is $45,000-$55,000 per year. This may vary depending on the specific job duties, experience level, and qualifications of the individual. Some employers may also offer additional benefits such as bonuses, health insurance, and retirement plans.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.