[Remote] Grievances & Appeals Representative at Humana

Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Two years of experience in customer service
Previous experience working in the healthcare and/or medical field
Excellent data entry capabilities
Proficiency with Microsoft Office, including intermediate skills in Outlook, Excel, and PowerPoint
Ability to adhere to process maps
Experience working in a fast-paced, production-oriented environment
Proven ability to prioritize tasks and manage inventory and workflow
Strong focus with keen analytical and decision-making abilities
Robust technical skills, including the capability to set up and connect a computer with additional monitors, navigate multiple software systems and applications simultaneously, and effectively work from home
Availability of a distraction-free workspace at home
Self-provided internet service meeting minimum download speed criteria
Ability to commit to full-time schedule: Training (5 weeks, Mon-Fri 8am-4:30pm EST, no time off allowed) and post-training (Mon-Fri 8am-4:30pm EST)
Willingness to remain in position for 18 months before applying to other opportunities

Responsibilities

Manage client medical denials through a thorough analytical review of clinical documentation to assess the necessity of an appeal
Perform advanced administrative and customer support tasks that demand independent initiative and judgment
Occasionally apply intermediate mathematical skills and regularly exercise discretion and judgment in prioritizing tasks, interpreting, and adapting procedures, processes, and techniques
Work under limited supervision from home

Skills

Key technologies and capabilities for this role

Grievances ManagementAppeals ProcessingClinical Documentation ReviewAnalytical ReviewCustomer SupportAdministrative OperationsMathematical Skills

Questions & Answers

Common questions about this position

Is this position remote?

Yes, this is a work-from-home position with virtual training and the regular schedule performed from the comfort of your home.

What is the schedule for this role?

Training is Monday-Friday, 8am-4:30pm EST for 5 weeks starting tentatively January 12th, 2026, with no time off allowed during training or the 180-day appraisal period. After training, the schedule is Monday-Friday, 8am-4:30pm EST.

What qualifications are required for this position?

Required qualifications include two years of customer service experience, previous healthcare or medical field experience, excellent data entry skills, proficiency with Microsoft Office (Outlook, Excel, PowerPoint at intermediate level), ability to adhere to process maps, and experience in a fast-paced environment.

What is the salary or compensation for this role?

This information is not specified in the job description.

What should I know about the training and commitment for this job?

Training is virtual, 5 weeks long, requires full attendance with no time off, and you must be on camera. You must commit to 18 months in the role before applying to other Humana opportunities.

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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