Remote Grievances & Appeals Specialist - Medicaid

Humana Inc; Salt Lake City (UT); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off & holidays

Job summary

Humana Inc. in Salt Lake City is seeking a Grievances & Appeals Representative 3 to process expedited Medicaid and AIP (dual) appeals. This high-volume role involves reviewing clinical documentation, managing cases from start to finish, and meeting tight turnaround times.

You will work with managers and team leads, make outbound calls to members or providers, and adapt to changing workflows. Training is virtual; after, schedule is 11:30 am–8:00 pm ET, Tuesday–Saturday, with potential remote work.

Qualifications

• 1+ years of customer service experience.
• 1+ years in the healthcare industry or medical field.
• Experience with production and meeting performance metrics.
• Experience using Microsoft Office and multiple software systems.
• Experience managing a high-volume, rapidly changing workload with minimal supervision.

Responsibilities

• Review expedited Medicaid and AIP (dual) appeals cases per hour.
• Manage cases from assignment to resolution with analytic reviews of clinical documentation.
• Assess case urgency and process cases with strict 24-hour turnaround times.

Skills

Customer service

Healthcare experience

Time management

Adaptability

Tools

Microsoft Office Suite

Job description

Humana Inc. in Salt Lake City is seeking a Grievances & Appeals Representative 3 to process expedited Medicaid and AIP (dual) appeals. This high-volume role involves reviewing clinical documentation, managing cases from start to finish, and meeting tight turnaround times.

You will work with managers and team leads, make outbound calls to members or providers, and adapt to changing workflows. Training is virtual; after, schedule is 11:30 am–8:00 pm ET, Tuesday–Saturday, with potential remote work.