Grievances & Appeals Specialist (Remote)

Humana, Inc.; Honolulu (HI); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to manage denials and concerns through analytic review of clinical documentation, delivering final determinations.

This remote role supports members and providers, applying policies while prioritizing workloads and collaborating with internal teams for resolution. The position emphasizes customer service, healthcare familiarity, and attention to detail, with standard 40-hour weeks and skilled use of Word and Excel.

Qualifications

• Previous customer service experience.
• Previous experience in the healthcare industry or medical field.
• Must have experience in a production driven environment.
• Intermediate experience with Microsoft Word and Excel.
• Ability to work an 8-hour shift Monday – Friday between the hours of 8am-8pm with flexibility to work overtime based on business needs.
• Must be passionate about contributing to an organization focused on continuously 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 manage tasks to 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

Education

Associate or Bachelor's Degree

Tools

Microsoft Word

Microsoft Excel

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to manage denials and concerns through analytic review of clinical documentation, delivering final determinations.

This remote role supports members and providers, applying policies while prioritizing workloads and collaborating with internal teams for resolution. The position emphasizes customer service, healthcare familiarity, and attention to detail, with standard 40-hour weeks and skilled use of Word and Excel.