Become a part of our caring community
 

The Grievances & Appeals Representative 4 supports the Medicare Internal Review Team by reviewing Level 1 appeal cases to make sure they are accurate, complete, and ready for the next step in the appeals process. In this role, you will help ensure cases are on time, meet Medicare compliance requirements and are properly documented for external review. You will support compliance tracking, audit readiness and issue resolution for members and providers.

As a Grievances and Appeals Representative, you will:

• Review Level 1 appeal cases for accuracy
• Ensure case documentation is ready for Independent Review Entity (IRE) submission
• Monitor case work to ensure quality, accuracy, compliance, timely closure and audit readiness
• Review cases to identify trends, risks, and escalate as needed
• Support achievement of monthly operational and compliance metrics.

Use your skills to make an impact
 

Required Qualifications

• 1+ year of healthcare or medical field experience
• 2+ years of experience with Grievances and Appeals
• Must have experience meeting expectations in a metrics driven environment

Preferred Qualifications

• Associate or bachelor's Degree
• Prior leadership experience (formal/informal/SME)
• Previous inbound call center or related customer service experience
• Experience processing medical claims
• Medicare experience

Additional Information

Workstyle: remote, work from home

Training schedule: 8:00 a.m. - 4:30 p.m. Monday, Through Friday, for up to 6 weeks. No time off allowed during training and is limited within the first 180 days.

Schedule following training: Must be able to work any 8-hour shift between 7am-7pm EST. Shifts will include one weekend day (Saturday or Sunday). 

Grievances and appeals work is complex and takes time to learn. You must be willing to stay in the department for at least 18 months before applying to other Humana roles.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

 

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

 

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$48,300 - $65,900 per year

 

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 11-19-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.