Senior Grievances & Appeals Analyst

Humana

Senior Grievances & Appeals Analyst at Humana analyzing complaints and ensuring integrity of claims and authorization processes. Collaborate with the Resolution team to improve business operations and audit findings.

Posted 6/3/2026full-timeKentucky, Texas, Utah, Virginia, Washington • 🇺🇸 United StatesSenior💰 $65,000 - $88,600 per yearWebsite

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisroot cause analysischange managementreportingauditingdata sortingpivot tablescomplex formulas

Soft Skills

continuous improvementtrend identificationproject managementdocumentation