Grievances & Appeals Representative

Humana

. Assign cases to team members for submission to an independent entity for second-level review .

Posted 9/23/2026full-timeRemote • United StatesJunior💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong capabilities in managing case assignments and performing thorough reviews of clinical documentation while adhering to established guidelines. Proficient in utilizing Microsoft systems to enhance productivity in a fast-paced, production-driven environment.

Highest-signal resume keywords

Customer Service ExperienceData Entry ExperienceMicrosoft Teams ProficiencyMicrosoft SharePoint ProficiencyBilingual English and Spanish

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryCase ManagementClinical Documentation ReviewGrievance AssessmentAppeals ProcessingInventory ManagementMedical Terminology

Soft Skills

Task PrioritizationAdaptabilityCollaboration

Tools & Technologies

Microsoft Excel

Industry Keywords

Inbound Call Center ExperienceMedicare Experience

About the role

Key responsibilities & impact

Assign cases to team members for submission to an independent entity for second-level review
Monitor and record the number of cases assigned to the team
Monitor distribution of cases among individual associates
Operate within established guidelines to meet work expectations and quality standards
Prioritize tasks and manage timelines with minimal supervision
Adapt to evolving processes and a fast-paced work environment
Perform thorough reviews of clinical documentation to assess grievances, appeals, and additional requests
Provide final determinations through collaboration with clinical and other Humana teams

Requirements

What you’ll need

Minimum of 1 year of customer service experience
Minimum of 1 year of data entry experience
Experience in a production-driven environment
Strong experience using multiple Microsoft systems simultaneously, including Teams, SharePoint, and Excel
Ability to manage large volume of inventory daily
Must reside in Central or Eastern Standard Time Zone (CST or EST)
Ability to work the specified training and post-training schedules
Previous inbound call center or related customer service experience preferred
Previous grievance and appeals experience preferred
Medical terminology experience preferred
Bilingual English and Spanish preferred, with ability to read, write, and speak both languages
Prior Medicare experience preferred

Benefits

Comp & perks

Medical, dental, and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Home-based remote work
Occasional travel to Humana offices for training or meetings
Dedicated work space and internet requirements to support work from home