Grievances & Appeals Specialist — Remote

Humana, Inc.; Salt Lake City (UT); Remoto; USD 40.000 - 52.000; Tempo pieno

Descrizione del lavoro

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers through grievance and appeal processes. You will apply policies to casework, prioritize tasks, and collaborate with internal teams to ensure quality service and compliant resolutions.

The role focuses on delivering thoughtful, accurate responses, maintaining records, and escalating complex issues as needed while supporting member experience goals.

Competenze

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

Mansioni

• 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.

Conoscenze

Customer service

Healthcare experience

Production environment

MS Word & Excel

Formazione

Associate's or Bachelor's Degree

Descrizione del lavoro

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers through grievance and appeal processes. You will apply policies to casework, prioritize tasks, and collaborate with internal teams to ensure quality service and compliant resolutions.

The role focuses on delivering thoughtful, accurate responses, maintaining records, and escalating complex issues as needed while supporting member experience goals.