Remote Grievances & Appeals Specialist

Humana Inc; Northern (KY); Hybrid; USD 40,000 - 52,000; Full time

Benefits offered by this job

Work from home

Health benefits

401(k)

Job summary

Humana Inc. is seeking a Grievances & Appeals Representative 2 to review and determine the justification of grievances and appeals.

You will assess clinical documentation and collaborate with clinical teams to provide final determinations, supporting Humana's commitment to quality service. Remote, work-from-home role based in Central or Eastern Time; training Monday–Friday, with a fixed 40-hour workweek and subsequent schedule variations including weekend shifts.

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 simultaneously (Teams, SharePoint, Excel, etc.).
• 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, 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.

Skills

Customer service

Data entry

Production environment

MS Teams

SharePoint

Excel

Inventory management

Tools

Microsoft Teams

SharePoint

Excel

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 2 to review and determine the justification of grievances and appeals.

You will assess clinical documentation and collaborate with clinical teams to provide final determinations, supporting Humana's commitment to quality service. Remote, work-from-home role based in Central or Eastern Time; training Monday–Friday, with a fixed 40-hour workweek and subsequent schedule variations including weekend shifts.