Remote Grievances & Appeals Specialist

Humana; Missouri; Remote; USD 40,000 - 52,000; Full time

Job summary

Humana is seeking a Grievances & Appeals Representative 2 to join its Internal Review Team. You will review clinical documentation and render final determinations in collaboration with clinical and Humana teams.

This remote role supports Humana’s mission to improve consumer experiences and requires strong data entry and customer service skills. Work closely with cross-functional teams, manage case loads, and adhere to guidelines.

Qualifications

• Minimum of 1 year of customer service experience.
• Minimum of 1 year of data entry experience.
• Experience in a production-driven environment.
• Must have strong experience using multiple Microsoft systems (Teams, SharePoint, Excel).
• Ability to manage large volume on inventory daily.

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, and the distribution among associates.
• Operate within guidelines to maintain work quality and timelines with minimal supervision.
• Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment.

Skills

Customer service

Data entry

Production environment

Microsoft Teams/SharePoint/Excel

Inventory management

Tools

Microsoft Teams

SharePoint

Excel

Job description

Humana is seeking a Grievances & Appeals Representative 2 to join its Internal Review Team. You will review clinical documentation and render final determinations in collaboration with clinical and Humana teams.

This remote role supports Humana’s mission to improve consumer experiences and requires strong data entry and customer service skills. Work closely with cross-functional teams, manage case loads, and adhere to guidelines.