Grievances & Appeals Specialist — Remote

Humana, Inc.; Carson City (NV); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to manage denials and concerns by performing analytic reviews of clinical documentation. The role supports members and providers, applying policies to prioritize work and deliver quality service.

This remote position may require travel to Humana offices for training or meetings. Responsibilities include investigating concerns, documenting interactions, explaining processes, and collaborating with internal teams to resolve complex

Qualifications

• Previous customer service experience.
• Healthcare industry or medical field experience.
• Experience in a production-driven environment.
• Intermediate experience with Microsoft Word and Excel.
• Ability to work an 8-hour shift Monday–Friday between 8am-8pm with overtime flexibility.
• Passionate about contributing to an organization focused on improving consumer experiences.

Responsibilities

• Assist members and providers with grievance and appeal inquiries.
• Investigate and resolve member and practitioner concerns.
• Document interactions and maintain accurate records.
• Explain processes, policies, and resolution outcomes.
• Research issues and gather information to support case resolution.
• Apply departmental policies and procedures to assigned work.
• Prioritize workload and meet service expectations.
• Collaborate with internal teams to resolve complex issues.
• Escalate concerns requiring additional review or action.

Skills

Previous customer service experience

Healthcare industry experience

Production-driven environment

Microsoft Word

Microsoft Excel

Flexible 8am–8pm schedule

Education

Associate's or Bachelor's Degree

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to manage denials and concerns by performing analytic reviews of clinical documentation. The role supports members and providers, applying policies to prioritize work and deliver quality service.

This remote position may require travel to Humana offices for training or meetings. Responsibilities include investigating concerns, documenting interactions, explaining processes, and collaborating with internal teams to resolve complex