Grievances & Appeals Specialist (Remote)

Humana, Inc.; Dover (DE); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers through grievance and appeal processes, with a focus on accurate documentation and timely resolutions.

This remote position may require occasional travel to Humana offices. It is a full-time 40-hour workweek with a pay range of $40,000 to $52,300 per year, plus benefits. You will work Monday–Friday 8am–8pm with potential overtime; prior healthcare/claims experience is valued.

Qualifications

• Previous customer service experience.
• Healthcare industry or medical field experience.
• Experience in a production-driven environment.
• Proficiency with Microsoft Word and Excel.
• Ability to work an 8-hour shift Mon-Fri 8am-8pm plus overtime.
• Passion for improving consumer experiences.
• Preferred: Associate's or Bachelor's Degree.
• Experience in medical claims processing.
• Inbound call center or related customer service experience.
• 1-3 years grievance and appeals experience.
• Medical terminology experience.
• Bilingual (English and Spanish).
• Prior Medicare knowledge.
• Experience with CAS (Claims Administration System).

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 manage tasks to meet service expectations.
• Collaborate with internal teams to resolve complex issues.
• Escalate concerns requiring additional review or action.
• Support quality, compliance, and member experience goals.

Skills

Customer service experience

Healthcare experience

Production-driven environment

Microsoft Word

Microsoft Excel

Flexible 8am–8pm shift

Improve consumer experiences

Education

Associate's or Bachelor's Degree

Medical claims processing experience

Inbound call center experience

Grievance & appeals experience (1-3 yrs)

Medical terminology experience

Bilingual English/Spanish

Medicare knowledge

Claims Administration System (CAS)

Tools

Microsoft Word

Microsoft Excel

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers through grievance and appeal processes, with a focus on accurate documentation and timely resolutions.

This remote position may require occasional travel to Humana offices. It is a full-time 40-hour workweek with a pay range of $40,000 to $52,300 per year, plus benefits. You will work Monday–Friday 8am–8pm with potential overtime; prior healthcare/claims experience is valued.