Humana
Become a part of our caring community and help us put health first
The Appeals Representative 4 Investigates and resolves member and practitioner issues. 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.
The Appeals Representative 4
Review documents
Building cases
Inventory Management
Data Entry
Use your skills to make an impact
Required Qualifications
3 or more years of Appeals experience
1 or more years' Healthcare experience
Strong data entry skills
Intermediate experience with Microsoft Word and Excel
Preferred Qualifications
Associate or Bachelor's Degree
Experience handling multiple projects and assignments as directed by management
Capacity to maintain confidentiality and work independently in support of the department
Experience with electronic inventory management; able to complete assigned cases in a specified time frame.
CAS, MedHOK experience strongly preferred
Previous experience processing medical claims
Required Work Schedule
This is a remote role and will provide coverage for
Eastern time zone hours
.
Training
Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00 AM - 4:30 PM EST, Monday - Friday.
Work Schedule Following Training
Must be able to work any 8-hour shift Monday - Thursday between 8:00 AM and 9:00 PM EST, with a minimum schedule of 10:00 AM EST - 6:30 PM EST on Fridays.
Weekend work is required on a rotating basis from 9:00 AM - 5:30 PM EST, based on business needs.
Overtime and holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.
Appeals (G&A) has an impact to our business, and, because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.
Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 09-12-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
?
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Appeals Representative 4 Investigates and resolves member and practitioner issues. 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.
The Appeals Representative 4
Review documents
Building cases
Inventory Management
Data Entry
Use your skills to make an impact
Required Qualifications
3 or more years of Appeals experience
1 or more years' Healthcare experience
Strong data entry skills
Intermediate experience with Microsoft Word and Excel
Preferred Qualifications
Associate or Bachelor's Degree
Experience handling multiple projects and assignments as directed by management
Capacity to maintain confidentiality and work independently in support of the department
Experience with electronic inventory management; able to complete assigned cases in a specified time frame.
CAS, MedHOK experience strongly preferred
Previous experience processing medical claims
Required Work Schedule
This is a remote role and will provide coverage for
Eastern time zone hours
.
Training
Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00 AM - 4:30 PM EST, Monday - Friday.
Work Schedule Following Training
Must be able to work any 8-hour shift Monday - Thursday between 8:00 AM and 9:00 PM EST, with a minimum schedule of 10:00 AM EST - 6:30 PM EST on Fridays.
Weekend work is required on a rotating basis from 9:00 AM - 5:30 PM EST, based on business needs.
Overtime and holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.
Appeals (G&A) has an impact to our business, and, because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.
Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 09-12-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
?
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.