Remote Grievances & Appeals Specialist

Humana Inc; Kentucky; Hybrid; USD 40,000 - 52,000; Full time

Job summary

Humana Inc. is seeking a Grievances & Appeals Representative 2 within its Internal Review Team to address member concerns and denials, review clinical documentation, and render final determinations in collaboration with clinical and other Humana teams.

This role emphasizes contributing to Humana’s commitment to high-quality service and positive member outcomes. The position is remote with required CST/EST hours, a Wednesday-Sunday schedule after training, and an 18-month commitment to the

Qualifications

• Minimum of 1 year of customer service experience.
• Minimum of 1 year of data entry experience.
• Experience in a production-driven environment.

Responsibilities

• Assign cases to team members for submission to an independent entity for 2nd level review.
• Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates.
• Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision.
• Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment.
• Use your skills to make an impact

Skills

Customer service

Data entry

Production environment experience

Tools

Microsoft Teams

SharePoint

Excel

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 2 within its Internal Review Team to address member concerns and denials, review clinical documentation, and render final determinations in collaboration with clinical and other Humana teams.

This role emphasizes contributing to Humana’s commitment to high-quality service and positive member outcomes. The position is remote with required CST/EST hours, a Wednesday-Sunday schedule after training, and an 18-month commitment to the