Remote Medicaid Appeals Specialist - High-Volume

Humana Inc; Carson City (NV); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

401(k) plan

Paid time off

Job summary

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation and moving cases efficiently.

This is a high-volume, fast-paced role with proactive queue management and cross‑functional collaboration, reporting to the Grievances & Appeals Supervisor. The position requires 1+ year(s) in customer service and healthcare, with proficiency in MS Office and the ability to work remotely on a fixed schedule.

Qualifications

• 1+ years of customer service experience.
• 1+ years of experience in the healthcare industry or medical field
• Must have experience with production and meeting performance metrics
• Intermediate experience with Microsoft Office programs (Word, Excel, Outlook, Teams) across multiple software systems
• Experience managing a high-volume, rapidly changing workload with shifting priorities

Responsibilities

• Review and evaluate several expedited Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution with analytic reviews of clinical documentation
• Assess case urgency and process cases with strict turnaround times (typically 24 hours)
• Make outbound calls on every case 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 industry

Performance metrics

MS Office

High-volume workload

Tools

Microsoft Office

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation and moving cases efficiently.

This is a high-volume, fast-paced role with proactive queue management and cross‑functional collaboration, reporting to the Grievances & Appeals Supervisor. The position requires 1+ year(s) in customer service and healthcare, with proficiency in MS Office and the ability to work remotely on a fixed schedule.