Grievances & Appeals Representative 3 Position Available In Essex, Massachusetts

Job Listing ID:

4318271

Job Title:

Grievances & Appeals Representative 3

Application Deadline:

Open Until Filled

Job Location:

Salem

Date Posted:

07/26/2025

Hours Worked Per Week:

Not Provided Shift:

Not Provided Duration of Job:

Either Full or Part Time, more than 6 months You may contact this employer directly.
(Obtain the contact information to print or add to your jobs.)

Job Summary:

Become a part of our caring community and help us put health first The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. The Grievances & Appeals Representative 3 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, andworks under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. Use your skills to make an impact Required Qualifications 1

• 3 years of customer service experience Less than 2 years of leadership experience Must have experience in the healthcare industry or medical field Strong data entry skills required Intermediate experience with Microsoft Word and Excel Must have experience in a production driven environment Shifts may be scheduled Monday
• Sunday 8
• 8 but be flexible with your hours based on business needs to work possible overtime Previous experience in the healthcare or medical fields Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Associate’s or Bachelor’s Degree Previous inbound call center or related customer service experience 1
• 3 years of grievance and appeals experience Previous experience processing medical claims Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish Prior experience with Medicare Experience with the Claims Administration System (CAS) Knowledge of medical terminology Ability to manage large volume of documents including tracking, copying, faxing and scanning Excellent interpersonal skills with ability to sensitively and compassionately interact with geriatric population

Additional Information Travel:

While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay 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. $43,000

• $56,200 per year 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 …

Job Classification:

Medical Secretaries and Administrative Assistants Access our statewide or regional occupation report for more information about wages,
employment outlooks, skills, training programs, related occupations, and more. Compensation

Salary:

Not Provided Job Requirements

Experience Required:

 See Job Summary

Education Required:

None

Minimum Age:

N/A Gender:

N/A