[Hiring] Senior Grievances & Appeals Analyst @Humana

Role Description

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.

• 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.

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.

Requirements

• Work schedule: 8 am to 5 pm EST.
• Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive benefits that support whole-person well-being.
• 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.

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.

$65,000 - $88,600 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Application Deadline

06-09-2026