Remote Grievances & Appeals Specialist

Humana, Inc.; Topeka (KS); Remote; USD 40,000 - 52,000; Full time

Job summary

Humana, Inc. in the United States seeks a Grievances & Appeals Representative to support members and providers with grievances and appeals, investigating concerns and applying policies to determine appropriate resolutions.

In a remote-friendly environment, you will document interactions, coordinate with internal teams, and ensure timely case resolutions while maintaining quality and compliance standards for member experience.

Qualifications

• Required customer service experience in a healthcare setting.
• Experience in a production-driven environment.
• Proficient in Microsoft Word and Excel.

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

Healthcare experience

Production environment

Microsoft Word

Excel

Flexible hours

Customer focus

Education

Associate's or Bachelor's Degree

Job description

Humana, Inc. in the United States seeks a Grievances & Appeals Representative to support members and providers with grievances and appeals, investigating concerns and applying policies to determine appropriate resolutions.

In a remote-friendly environment, you will document interactions, coordinate with internal teams, and ensure timely case resolutions while maintaining quality and compliance standards for member experience.