Remote Grievances & Appeals Specialist — Medicaid (Fast-Paced)

Humana Inc; Topeka (KS); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals. This is a high-volume, fast-paced role requiring proactive queue management and effective communication with managers and team leads.

You will review clinical documentation, manage cases end-to-end, and ensure timely turnaround while maintaining quality. Training and remote work options may be provided as part of Humana's flexible environment.

Qualifications

• 1+ years of customer service experience.
• 1+ years in healthcare/medical field.
• Experience with production and meeting performance metrics.
• Proficient with Microsoft Office and multiple software systems.
• Managing a high-volume, changing workload with shifting priorities.

Responsibilities

• Review expedited Medicaid and dual-eligible cases per hour.
• Manage cases from assignment to resolution with analytic reviews.
• Assess case urgency and process in chronological order within 24 hours.
• Make outbound calls to deliver outcomes or request documentation.
• Stay current with mentor documents and workflows.
• Monitor multiple workstreams and adapt to process changes.
• Communicate gaps or issues and seek guidance as needed.

Skills

Customer service

Healthcare experience

High-volume workload

Multi-system usage

Microsoft Office

Tools

Microsoft Office Suite

Teams

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals. This is a high-volume, fast-paced role requiring proactive queue management and effective communication with managers and team leads.

You will review clinical documentation, manage cases end-to-end, and ensure timely turnaround while maintaining quality. Training and remote work options may be provided as part of Humana's flexible environment.