Remote Grievances & Appeals Specialist

Humana, Inc.; Juneau (AK); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to manage member and provider inquiries, investigate concerns, and apply policies to resolve grievances and appeals.

This remote-position requires strong customer service in healthcare and ability to handle production-driven work. The role involves documenting interactions, coordinating with internal teams, and delivering timely, accurate determinations while ensuring compliance and quality member experience.

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.
• Support quality, compliance, and member experience goals.

Skills

Customer service experience

Healthcare industry experience

Production driven environment

MS Word and Excel

OT flexibility

Education

Associate's or Bachelor's Degree

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to manage member and provider inquiries, investigate concerns, and apply policies to resolve grievances and appeals.

This remote-position requires strong customer service in healthcare and ability to handle production-driven work. The role involves documenting interactions, coordinating with internal teams, and delivering timely, accurate determinations while ensuring compliance and quality member experience.