Remote Medicaid Appeals Case Specialist

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

Job summary

Humana is seeking a Grievances & Appeals Representative 3 to efficiently process expedited Medicaid and AIP (dual) appeals while reviewing clinical documentation. This is a high-volume, fast-paced role with a focus on timely resolutions.

This remote position requires proactive queue management, strong communication with managers and team leads, and the ability to adapt to changing processes. Training and travel considerations are part of the role.

Qualifications

• 1+ years of customer service experience.
• 1+ years in healthcare/medical field.
• Experience with production and meeting performance metrics.
• Proficient in Word, Excel, Outlook, Teams; comfortable with multiple software systems.
• Capable of handling a high-volume, rapidly changing workload while staying self-sufficient.

Responsibilities

• Review and evaluate expedited Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution and review clinical documentation.
• Assess urgency and process within strict turnaround times (typically 24 hours).
• Make outbound calls to deliver outcomes or request documentation and clarify details.
• Monitor multiple workstreams and adapt quickly to process changes; communicate gaps as needed.

Skills

Customer service

Healthcare experience

Performance metrics

Microsoft Office

High-volume workload

Tools

Microsoft Office Suite

Job description

Humana is seeking a Grievances & Appeals Representative 3 to efficiently process expedited Medicaid and AIP (dual) appeals while reviewing clinical documentation. This is a high-volume, fast-paced role with a focus on timely resolutions.

This remote position requires proactive queue management, strong communication with managers and team leads, and the ability to adapt to changing processes. Training and travel considerations are part of the role.