The Senior Grievances & Appeals Analyst/ Professional analyzes and audits complaints received by the plan to ensure the integrity of claims, authorization processes, and business operations. You will report to the Associate Director, Grievances and Appeals, and be a part of the Resolution team.
As a Senior Grievances & Appeals Professional, you will:
Analyze and audit complaints received by the plan to ensure the integrity of claims, authorization processes, and business operations.
Utilize established process guidelines and industry knowledge to validate organizational decisions and assess downstream and upstream impacts
Perform root cause analysis of audit findings and make recommendations for appropriate change management.
Emphasize continuous improvement by identifying opportunities to reduce redeterminations, complaints, and rework of claims.
Identify trends and areas of improvement resulting from information obtained through the Resolution team resources and available reporting/data.
Use your skills to make an impact
Required Qualifications:
5 or more years of healthcare services experience in Sales, enrollment, Complaints to Medicare (CTMs)
1 or more years auditing experience
Experience using data analysis tools (such as Excel, SQL, or Power Bi) to create and analyze reports to identify trends
Demonstrated knowledge using advanced features in Microsoft Excel, including data sorting, pivot tables, and complex formulas.
Experience managing concurrent projects, maintaining thoroughly documented outcomes and minimal data entry error rates.
Preferred Qualifications:
Bachelor's degree
Experience with claims or authorization experience
Additional Information
Work schedule: 8 am to 5pm EST
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Work at Home
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. Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 06-09-2026About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Skills Required
- 5 or more years of healthcare services experience
- 1 or more years auditing experience
- Experience using data analysis tools (such as Excel, SQL, or Power Bi)
- Demonstrated knowledge using advanced features in Microsoft Excel
- Experience managing concurrent projects
Humana Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Humana and has not been reviewed or approved by Humana.
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Healthcare Strength — Medical, dental, vision, supplemental health, and long-term care insurance are offered alongside on-site/virtual wellness resources and weekly paid well-being time, indicating a whole-person focus.
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Leave & Time Off Breadth — Paid PTO and holidays, volunteer time, and formal leave options such as parental and caregiver time provide broad time-away support. Adoption assistance and lactation rooms extend coverage for key life events.
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Retirement Support — A 401(k) with company match anchors long-term savings. Employer-matched emergency savings programs complement retirement planning.
Humana Insights
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
