[Remote] Job Posting Title Grievances & Appeals Representative

Note: The job is a remote job and is open to candidates in USA. Humana is a company committed to putting health first for its teammates and customers. The Grievances & Appeals Representative 2 manages client denials and concerns, conducting analytic reviews of clinical documentation to determine if grievances or appeals are warranted, while also assisting members and resolving issues. Responsibilities Manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties Performs varied activities and moderately complex administrative/operational/customer support assignments Performs computations Typically works on semi-routine assignments Assists members, via phone or face to face, further/support quality related goals Investigates and resolves member and practitioner issues Decisions are typically focus on interpretation of area/department policy and methods for completing assignments Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion Skills Minimum one, (1) year of customer service experience, healthcare industry or medical field experience Must have experience in a production driven environment Intermediate experience with Microsoft Word and Excel Strong data entry skills required Must be passionate about contributing to an organization focused on continuously improving consumer experiences Associate's or Bachelor's Degree Previous experience in medical claims processing Grievance and appeals experience Medical terminology experience Prior experience with Medicare Ability to manage large volume of documents including tracking, copying, faxing and scanning Excellent interpersonal skills with ability to sensitively and compassionately interact with geriatric population Benefits Medical, dental and vision benefits 401(k) retirement savings plan Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) Short-term and long-term disability Life insurance Many other opportunities Company Overview Humana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship Humana has a track record of offering H1B sponsorships, with 282 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.