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Added 1 min ago
Community Mental Health Associate
Cascadia Health
Portland, OR
Position Description: The Community Mental Health Associate works independently and as a member of a team to provide engagement, housing placement, and time-limited home-based retention…
Added 2 mins ago
Senior Registered Client Associate
Wells Fargo Clearing Services, LLC
BRENTWOOD, TN
Wells Fargo is seeking a Senior Registered Client Associate in Wealth and Investment Management as part of Wells Fargo Advisors. Learn more about the career areas and business divisions at…
Added 4 mins ago
S
Seasonal Associate
sephora.com
Woodcliff Lake
- $21.75 to $24.88 USD / hour
As a Seasonal Associate, you'll be responsible for providing an outstanding client experience by supporting both store operations and onstage service during peak business moments. You'll…
Added 5 mins ago
Direct Support Professional (Community Homes)
UnityPoint Health
Manchester, IA
Associate’s degree in human service-related field preferred.
Added 5 mins ago
Associate Financial Advisor
Wells Fargo Clearing Services, LLC
BROOKLYN, NY · NY
At Wells Fargo, an Associate Bank Financial Advisor helps clients work toward their financial goals in collaboration with the bank branch team. You will build client relationships, provide…
Added 5 mins ago
Associate Director, Client Development – Funds
Simpson Thacher & Bartlett LLP
NY · San Francisco, CA · Boston, MA · Los Angeles, CA · Washington, DC · Houston, TX · Palo Alto, CA
Simpson Thacher serves as counsel and trusted adviser to the world’s most successful and innovative sponsors. The Client Development & Engagement (CDE) function sits at the heart of the…
Added 8 mins ago
Assignments Occupancy Manager-Traditional Halls
Louisiana State University and Agricultural and Mechanical College
United States
Supervision and Personnel Leadership (20%): Customarily and regularly direct the work of assigned part-time professional and/or student employees whose combined appointments equal at least…
Added 10 mins ago
CI
Samsung Experience Consultant Lead
Companies, Inc.
Lubbock, TX
- $19 USD / hour
Become a Full-Time Retail Sales Associate* for Samsung Electronics America (SEA)!
Added 10 mins ago
CI
Samsung Experience Consultant Lead
Companies, Inc.
Florence, KY
- $19 USD / hour
Become a Full-Time Retail Sales Associate* for Samsung Electronics America (SEA)!
Added 10 mins ago
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Samsung Experience Consultant (PT)
Companies, Inc.
SeaTac, WA
- $19 USD / hour
Become a Part-Time Retail Sales Associate* for Samsung Electronics America (SEA)!
Added 10 mins ago
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Samsung Experience Consultant (PT)
Companies, Inc.
Dayton, OH
- $17.5 USD / hour
Become a Part-Time Retail Sales Associate* for Samsung Electronics America (SEA)!
Added 10 mins ago
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Retail Sales Associate
Companies, Inc.
Bedford, TX
- $1,000 to $1,350 USD / week
Health benefits, paid time off, and 401k with company match
Added 11 mins ago
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Retail Sales Associate
Companies, Inc.
Dallas, TX
- $1,000 to $1,350 USD / week
Health benefits, paid time off, and 401k with company match
Added 11 mins ago
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HP Retail Sales Representative
Companies, Inc.
Estero, FL
- $16 USD / hour
Become a Part-Time HP Retail Sales Associate!
Added 12 mins ago
Surge Merchandiser - WATERTOWN, SD
Retail Execution West LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 12 mins ago
Surge Merchandiser - PETAL, MS
Retail Execution East LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 12 mins ago
Surge Merchandiser - Morehead, KY
Retail Execution East LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 12 mins ago
Surge Merchandiser - MIDDLESBORO, KY
Retail Execution East LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 12 mins ago
Surge Merchandiser - Artesia, NM (E)
Retail Execution West LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 12 mins ago
Retail Merchandiser - Port Richey, FL (E)
Retail Execution East LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 13 mins ago
Retail Merchandiser - Hope, AR (E)
Retail Execution West LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 13 mins ago
Flex Associate - Ephrata, PA (E)
Retail Execution East LLC
United States
We offer flexible hours, competitive pay, and great benefits for both full and part-time associates.
Added 15 mins ago
Corporate Accounting Billing Specialist
SII Saulsbury Industries, Inc
Houston, TX · Abilene, TX
…invoices in a timely and accurate manner. This role plays a key part in managing the billing cycle, ensuring compliance with corporate policies, resolving billing discrepancies, and…
Added 17 mins ago
Tax Senior Associate, SALT
Baker Tilly Advisory Group, LP
United States
Strong skills in time management, communication, analytical thinking, and client service.
Added 26 mins ago
Customer Success Lead
RBW Logistics, LLC
United States
B2B process standing and on schedule; discrepancies identified, documented, and resolved within defined Service Level Agreement (SLA) KC receives reconciliation on time.

Closed listing

Humana

Grievance & Appeals Representative

United States

$40,000 - $52,300 per year

This opening has closed.

The original listing is kept below for reference.

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Job details

Pay: $40,000 - $52,300 per year
Working hours: 40 hours per week
Posting language: English
Posted: Aug 19, 2026

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Original job description

Archived listing. The details below describe a past opening.

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The Grievances & Appeals Representative 2 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. The Grievances & Appeals Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

The Grievances & Appeals Representative supports members and providers by addressing concerns, resolving issues, and assisting with grievance and appeal processes. This role applies established policies and procedures while exercising judgment to prioritize work, interpret guidelines, and deliver quality service.

As a Grievances & Appeals Representative you will:

Assist members and providers with grievance and appeal inquiries.
Investigate and resolve member and practitioner concerns.
Document interactions and maintain accurate records.
Explain processes, policies, and resolution outcomes.
Research issues and gather information to support case resolution.
Apply departmental policies and procedures to assigned work.
Prioritize workload and manage tasks to meet service expectations.
Collaborate with internal teams to resolve complex issues.
Escalate concerns requiring additional review or action.
Support quality, compliance, and member experience goals.

Use your skills to make an impact

Required Qualifications

Previous customer service experience
Previous experience in the healthcare industry or medical field
Must have experience in a production driven environment
Intermediate experience with Microsoft Word and Excel
Ability to work an 8-hour shift Monday – Friday between the hours of 8am-8pm with flexibility to work overtime based on business needs
Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Associate's or Bachelor's Degree
Previous experience in medical claims processing
Previous inbound call center or related customer service experience
1 - 3 years of grievance and appeals experience
Medical terminology experience
Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish
Prior experience with Medicare
Experience with the Claims Administration System (CAS)
Knowledge of medical terminology
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

Additional Information

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.

$40,000 - $52,300 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.

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.

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.

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