Clinical Legal Advisor - Administrative Appeals

Become a part of our caring community and help us put health first
 

The Legal Advisor performs a variety of law-related tasks such as legal research, drafting legal documents and other related duties. The Legal Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

The Legal Advisor will support Humana’s Law Department’s representation of Humana in Medicare administrative appeals.  Responsibilities will include reviewing appeal case files to determine the level of clinical support needed for administrative law judge (ALJ) hearings, providing testimony at ALJ hearings, preparing clinical arguments and position summaries in connection with administrative appeals, and supporting the identification of trends and data monitoring impacting ALJ hearings.  The Legal Advisor will also be expected to advise executives to develop functional strategies on matters of significance; exercise independent judgment and decision making on complex issues regarding job duties and related tasks, work under minimal supervision, and uses independent judgment requiring analysis of variable factors and determining the best course of action.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• Active Nursing or other Clinical License
• Effective interpersonal, teaming and communication
• Proficiency with Microsoft Office programs (emphasis in Word, Excel, and PowerPoint), Adobe Professional
• Excellent research and writing skills
• Proven organizational skills, as well as flexibility, and ability to manage multiple or competing priorities within designated time frames and adjust priorities in a fast-paced environment
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Paralegal experience
• Corporate law or compliance department or law firm paralegal experience preferably with experience in medical or Medicare/Medicaid insurance
• Experience involving the Medicare administrative appeals process

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.

 

$104,000 - $143,000 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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: 06-29-2025

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.