Grievances & Appeals Representative

About the role

Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials by performing thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified and providing final determinations using your expertise and collaboration with clinical and other Humana teams. This role supports Humana's commitment to delivering high‑quality service and making a positive difference in the lives of those we serve. The position is remote (work from home) and requires residence in the Central or Eastern Standard Time Zone. An 18‑month commitment to the Grievances & Appeals department is required, with no transfers outside the area before the commitment ends. Associates must have a dedicated, interruption‑free workspace to protect member PHI/HIPAA information, provide their own internet service meeting a minimum of 25 Mbps download and 10 Mbps upload (wireless, cable or DSL suggested), and be prepared for occasional travel to Humana offices for training or meetings. Must be