Remote Grievances & Appeals Specialist

Humana, Inc.; Lincoln (NE); Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) retirement plan

Paid time off & holidays

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers with grievance and appeal processes. You will investigate concerns, document interactions, and apply policies to deliver timely, quality resolutions.

The role operates in a remote setup with occasional travel to Humana offices for training. Qualifications include prior customer service experience, healthcare exposure, and proficiency with Word/Excel.

Qualifications

• Prior customer service experience in healthcare preferred.
• Experience in a production-driven environment.
• Strong Microsoft Word and Excel skills.

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

Microsoft Word

Microsoft Excel

Education

Associate's or Bachelor's Degree

Tools

Microsoft Word

Microsoft Excel

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to support members and providers with grievance and appeal processes. You will investigate concerns, document interactions, and apply policies to deliver timely, quality resolutions.

The role operates in a remote setup with occasional travel to Humana offices for training. Qualifications include prior customer service experience, healthcare exposure, and proficiency with Word/Excel.