Remote Medicaid Grievances & Appeals Specialist

Humana Inc; Montpelier (VT); 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, review clinical documentation, and collaborate with partners. This is a high-volume, fast-paced role with strict turnaround times and outbound case follow-ups.

You will report to the Grievances & Appeals Supervisor. The position requires at least 1 year in customer service and healthcare, proficiency with Microsoft Office, and the ability to adapt to changing processes while

Qualifications

• 1+ year of customer service experience.
• 1+ year in the healthcare industry or medical field.
• Experience with production and meeting performance metrics.
• Intermediate MS Office (Word, Excel, Outlook, Teams) across multiple systems.

Responsibilities

• Review expedited Medicaid and AIP (dual) cases per hour.
• Manage cases from assignment to resolution with investigations.
• Assess urgency and process cases with strict 24-hour turnaround.
• Make outbound calls to deliver outcomes or request docs.
• Stay current with mentor documents and workflows; adapt to changes.

Skills

Customer service

Healthcare experience

MS Office

High-volume workload

Tools

Microsoft Office Suite

Job description

Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, review clinical documentation, and collaborate with partners. This is a high-volume, fast-paced role with strict turnaround times and outbound case follow-ups.

You will report to the Grievances & Appeals Supervisor. The position requires at least 1 year in customer service and healthcare, proficiency with Microsoft Office, and the ability to adapt to changing processes while