Remote Grievances & Appeals Specialist

Humana; United States; Remote; USD 40,000 - 52,000; Full time

Benefits offered by this job

Remote position

Occasional travel for training

Job summary

Humana is seeking a Grievances & Appeals Representative 2 to support members and providers by addressing concerns, resolving issues, and guiding grievance and appeal processes. You will apply established policies, document interactions, and escalate when needed to ensure high-quality service.

This remote, full-time role requires customer service experience, familiarity with healthcare settings, and the ability to work 8-hour shifts Mon–Fri 8am–8pm with some overtime.

Qualifications

• Previous customer service experience.
• Previous experience in the healthcare industry or medical field.
• Must have experience in a production driven environment.
• Intermediate experience with Microsoft Word and Excel.
• Ability to work an 8-hour shift Monday – Friday between the hours of 8am-8pm with flexibility to work overtime based on business needs.
• Must be passionate about contributing to an organization focused on continuously 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.
• Support quality, compliance, and member experience goals.

Skills

Customer service

Healthcare industry experience

Production driven environment

Bilingual English/Spanish

Medical terminology knowledge

Interpersonal skills (geriatric care)

Education

Associate’s or Bachelor’s Degree

Tools

Microsoft Word

Microsoft Excel

Job description

Humana is seeking a Grievances & Appeals Representative 2 to support members and providers by addressing concerns, resolving issues, and guiding grievance and appeal processes. You will apply established policies, document interactions, and escalate when needed to ensure high-quality service.

This remote, full-time role requires customer service experience, familiarity with healthcare settings, and the ability to work 8-hour shifts Mon–Fri 8am–8pm with some overtime.