Remote Grievances & Appeals Specialist

Humana, Inc.; Salem (OR); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative to assist members and providers with grievance and appeal inquiries, investigate concerns, and document interactions.

The role supports quality and member experience goals within a remote, production-driven environment. Typical duties include applying policies, prioritizing workload, and collaborating with internal teams to resolve complex issues while complying with HIPAA and establishing processes.

Qualifications

• Previous customer service experience.
• Experience in the healthcare industry or medical field.
• Experience in a production-driven environment.
• Intermediate experience with Microsoft Word and Excel.
• Ability to work an 8-hour shift Monday–Friday between 8am–8pm with flexibility for overtime.
• Passionate about contributing to an organization focused on 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.

Skills

Customer service

Healthcare experience

Production environment

MS Word & Excel

Schedule flexibility

Customer experience focus

Education

Associate's or Bachelor's Degree

Medical terminology knowledge

Tools

CAS (Claims Administration System)

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative to assist members and providers with grievance and appeal inquiries, investigate concerns, and document interactions.

The role supports quality and member experience goals within a remote, production-driven environment. Typical duties include applying policies, prioritizing workload, and collaborating with internal teams to resolve complex issues while complying with HIPAA and establishing processes.