Remote Grievances & Appeals Specialist

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

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off and holidays

Disability insurance

Life insurance

Job summary

Humana, Inc. is seeking a Grievances & Appeals Representative 2 to manage denials and member/provider concerns through comprehensive review of clinical documentation and coordination with clinical teams.

The role involves semi-routine administrative and customer support tasks, resolving issues, and documenting interactions while applying established policies to deliver quality service. Remote work with travel to Humana offices as needed.

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 8am-8pm with flexibility to work overtime.
• 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

Microsoft Word

Microsoft Excel

Education

Associate's or Bachelor's Degree

Tools

Microsoft Word

Microsoft Excel

Job description

Humana, Inc. is seeking a Grievances & Appeals Representative 2 to manage denials and member/provider concerns through comprehensive review of clinical documentation and coordination with clinical teams.

The role involves semi-routine administrative and customer support tasks, resolving issues, and documenting interactions while applying established policies to deliver quality service. Remote work with travel to Humana offices as needed.