Remote Expedited Medicaid Appeals Specialist

Humana Inc; Boise (ID); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

401(k) plan

Paid time off

Parental leave

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation to determine if appeals are warranted.

This fast-paced role requires proactive queue management and effective communication with managers and leads. You will report to the Grievances & Appeals Supervisor and work in a remote setup with possible travel for training or meetings.

Qualifications

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

Responsibilities

• Review and evaluate expedited Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution with analytic reviews of clinical docs.
• Assess case urgency and process in chronological order with tight turnaround times (≈24 hours).
• Make outbound calls to deliver outcomes or request documentation.
• Stay current with mentor documents and workflows.
• Monitor multiple workstreams and adapt to process changes.
• Communicate gaps or issues and seek guidance as needed.

Skills

Customer service

Healthcare

Metrics

MS Office

High-volume

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation to determine if appeals are warranted.

This fast-paced role requires proactive queue management and effective communication with managers and leads. You will report to the Grievances & Appeals Supervisor and work in a remote setup with possible travel for training or meetings.