Remote Grievances & Appeals Specialist (Medicare Part B)

Humana; United States; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Remote work

Full-time position

Competitive benefits

Job summary

Humana is seeking a Grievances & Appeals Representative 3 to manage Part B denials and concerns through comprehensive review of clinical docs. This remote role supports members and providers, with a focus on efficiency, accuracy, and compliant handling of appeals and grievances.

The position requires healthcare familiarity, a year or more in G&A, and strong data entry. Flexible scheduling and potential overtime reflect the organization's commitment to timely resolutions.

Qualifications

• 1+ years of customer service experience (call center or retail).
• Experience in healthcare, pharmaceutical, or medical field.
• 1+ years of grievance and appeals (G&A) experience.
• Experience in a production and QA-driven environment.
• Strong data entry skills including Word and Excel.

Responsibilities

• Assist members and provider offices by phone.
• Investigate and resolve member and practitioner issues for Part B claims.
• Follow production goals and QA metrics.
• Make decisions on methods, tactics, and processes for tasks.
• Exercise discretion in prioritizing requests and procedures.
• Work in a remote work-at-home setting with limited guidance.

Skills

Customer service

Healthcare experience

G&A experience

Data entry

Microsoft Excel

Tools

PaHub

Job description

Humana is seeking a Grievances & Appeals Representative 3 to manage Part B denials and concerns through comprehensive review of clinical docs. This remote role supports members and providers, with a focus on efficiency, accuracy, and compliant handling of appeals and grievances.

The position requires healthcare familiarity, a year or more in G&A, and strong data entry. Flexible scheduling and potential overtime reflect the organization's commitment to timely resolutions.