[Hiring] Grievances & Appeals Representative REMOTE USA
Position: Grievances & Appeals Representative
Date Posted: August 18, 2025
Industry: Healthcare / Insurance
Employment Type: Full Time
Experience: 3+ years in Grievance & Appeals, 1+ year Healthcare experience
Qualification: Associate or Bachelor’s Degree preferred
Salary: $48,300 – $65,900 per year
Location: Florida, United States [Remote – Eastern Time Zone coverage required]
Company: Humana
Description:
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Humana is seeking a detail-oriented Grievances & Appeals Representative to join our remote team. In this role, you will investigate and resolve member and practitioner concerns, manage client denials, and review clinical documentation to determine if a grievance, appeal, or further request is warranted.
Key Responsibilities:
- Review documents and build cases for grievances and appeals.
- Manage inventory and data entry for assigned cases.
- Ensure timely and accurate completion of appeals in a production-driven environment.
Required Qualifications:
- 3+ years of experience in Grievance & Appeals.
- 1+ year of healthcare experience.
- Strong data entry skills and proficiency with Microsoft Word and Excel.
- Ability to handle multiple projects in a production-driven environment.
Preferred Qualifications:
- Associate or Bachelor’s degree.
- Experience managing multiple projects under guidance from management.
- Ability to maintain confidentiality and work independently.
- Experience with electronic inventory management.
- CAS or MedHOK system experience preferred.
- Prior experience processing medical claims.
Work Schedule:
- Remote role providing coverage for Eastern Time Zone hours.
- Virtual training during the first 6–8 weeks, Monday – Friday, 8:00 AM – 4:30 PM EST.
- Post-training, 8-hour shifts Monday – Thursday between 8:00 AM and 9:00 PM EST; Fridays minimum 10:00 AM – 6:30 PM EST.
- Weekend rotation and occasional overtime/holiday work may be required.
- 18-month commitment to the department is required.
Technology & Equipment Requirements:
- Minimum home internet speed: 25 Mbps download / 10 Mbps upload.
- Satellite, cellular, or microwave connections only if approved.
- Dedicated home workspace required for confidentiality and HIPAA compliance.
- Company-provided telephone equipment for work.
Additional Information:
- Virtual interviews via HireVue (pre-recorded voice or SMS) may be part of the selection process.
- Occasional travel to Humana offices for training or meetings may be required.
- Scheduled weekly hours: 40.
Benefits:
- Comprehensive medical, dental, and vision coverage.
- 401(k) retirement savings plan.
- Paid time off, company and personal holidays, volunteer time off.
- Paid parental and caregiver leave.
- Short- and long-term disability coverage and life insurance.
Humana is an equal opportunity employer committed to diversity, equity, and inclusion, ensuring employment decisions are based solely on valid job requirements and qualifications.
Disclaimer: The job details above are structured for clarity and based on publicly available content from recruiters/Company pages. All rights remain with the original source; names may be withheld for confidentiality. We are not involved in the hiring process.
