Grievance & Appeals Representative

Candidates must have at least 1 year of customer service experience, leadership experience (indirect or direct), and experience in the healthcare or medical field. Strong data entry skills are required, along with proficiency in Microsoft Office, particularly Word and Excel. Experience in a production-driven environment and the ability to manage inventory and workflow are essential. Candidates must possess customer-focused, analytical, and decision-making skills, along with strong technical abilities to work across multiple software systems comfortably and remotely. A willingness to remain in the position for twelve months before applying for other Humana opportunities is also required. Preferred qualifications include an Associate or Bachelor's degree, previous inbound call center or related customer service experience, grievance and appeals experience, prior experience interpreting member benefits and medical claims, previous experience processing medical authorizations, bilingual skills in English and Spanish, prior Medicare experience, experience with the Claims Administration System (CAS), knowledge of medical terminology, and excellent interpersonal skills with the ability to interact sensitively with the geriatric population.