Remote Medicaid Grievances & Appeals Specialist

Humana Inc; Little Rock (AR); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana, Inc. invites applications for a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation and moving cases through a fast-paced process.

The role emphasizes proactive queue management and cross-functional collaboration with managers and team leads. The position requires 1+ years in customer service and healthcare, comfort with MS Office, and the ability to meet tight turnaround times.

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, and Teams) and comfortability working across multiple software systems
• Experience managing a high-volume, rapidly changing workload while remaining self-sufficient, managing shifting priorities, and adapting to new processes without disruption

Responsibilities

• Review and evaluate several expedited Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution, conducting analytic reviews of clinical documentation and collaborating with business partners to complete investigations.
• Assess case urgency and process cases in chronological order, ensuring resolution within strict turnaround times (typically 24 hours).
• Make outbound calls on every case to deliver outcome to members or providers, or request documentation, clarify case details or address outstanding issues.
• Stay current with frequently changing mentor documents and workflows.
• Monitor multiple workstreams and adapt quickly to process changes.
• Communicate gaps or issues and seek guidance as needed.

Skills

Customer service

Healthcare experience

Performance metrics

MS Office

Multitasking

Tools

Microsoft Office

Job description

Humana, Inc. invites applications for a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation and moving cases through a fast-paced process.

The role emphasizes proactive queue management and cross-functional collaboration with managers and team leads. The position requires 1+ years in customer service and healthcare, comfort with MS Office, and the ability to meet tight turnaround times.