Remote Grievances & Appeals Specialist

Humana, Inc.; Cheyenne (WY); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Disability insurance

Parental leave

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers by addressing concerns and guiding grievance and appeal processes.

This role requires applying policies, prioritizing work, and delivering quality service with careful documentation. The position emphasizes production-driven experience, strong Excel/Word skills, and the ability to work a Monday–Friday 8am–8pm schedule with possible overtime involvement, contributing to ongoing improvements in consumer

Qualifications

• Previous customer service experience.
• Healthcare industry or medical field experience preferred.
• Experience in a production-driven environment.
• Intermediate Microsoft Word and Excel skills.
• Ability to work an 8-hour shift Mon–Fri, 8am–8pm, with overtime as needed.
• Interest in 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

Customer service

Healthcare experience

Production environment

Word & Excel

Grievances & appeals

Bilingual (EN/ES)

Education

Associate's or Bachelor's Degree

Tools

CAS (Claims Admin System)

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers by addressing concerns and guiding grievance and appeal processes.

This role requires applying policies, prioritizing work, and delivering quality service with careful documentation. The position emphasizes production-driven experience, strong Excel/Word skills, and the ability to work a Monday–Friday 8am–8pm schedule with possible overtime involvement, contributing to ongoing improvements in consumer