Remote Expedited Grievances & Appeals Case Specialist

Humana Inc; Northern (KY); Hybrid; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. seeks a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals.

This remote, nationwide role reviews clinical documentation for decisioning, working in a high-volume, fast-paced environment with proactive communication to managers and team leads. You will manage cases from assignment to resolution, conduct analytic document reviews, and ensure timely processing while coordinating with business partners.

Qualifications

• 1+ years of customer service experience.
• 1+ years of experience in the healthcare industry or medical field.
• Experience meeting production and performance metrics.
• Intermediate experience with Microsoft Office programs (Word, Excel, Outlook, Teams) and multi-system workflows.

Responsibilities

• Review and expedite Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution with analytic reviews.
• Assess case urgency and maintain turnaround times (approx. 24 hours).
• Make outbound calls to deliver outcomes or request documentation.
• Stay current with mentor documents and workflows; communicate gaps as needed.
• Monitor multiple workstreams and adapt to process changes.

Skills

Customer service

Healthcare experience

Microsoft Office

Multi-system navigation

High-volume workload

Tools

Microsoft Office

Job description

Humana Inc. seeks a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals.

This remote, nationwide role reviews clinical documentation for decisioning, working in a high-volume, fast-paced environment with proactive communication to managers and team leads. You will manage cases from assignment to resolution, conduct analytic document reviews, and ensure timely processing while coordinating with business partners.