James Mcniff

I am a grievance and appeals representative who manages client denials and concerns through comprehensive analytic review of clinical documentation. I determine when a grievance, appeal, or further request is warranted and deliver final determinations in partnership with clinical teams and Humana stakeholders.

My background spans Humana grievance and appeals work, ASU call center support, and prior risk management at Kroger.

I lead and trained a bailout team of 6–8 associates, served as a subject matter expert, and consistently support quality-related goals through advanced administrative and operational judgment while resolving member and practitioner issues.