by Rat Race Rebellion July 21, 2026
About Humana
Humana Inc. is a prominent U.S. healthcare company committed to enhancing the quality of life for its members. Through its insurance services and CenterWell healthcare services, Humana provides essential care to millions, including those with Medicare and Medicaid. The company is dedicated to delivering services that improve the health and well-being of individuals and communities.
As a full-time, remote position, the Grievances and Appeals Representative role offers flexibility with a schedule that requires availability from Sunday to Saturday, between 8 a.m. and 7 p.m. EST. The role demands adaptability to meet business needs, including potential overtime.
What Your Day Will Look Like
In this role, representatives manage member and provider denials, conduct analytic reviews of clinical documentation, and deliver final determinations. Daily tasks include assisting members and providers by phone, investigating and resolving issues related to Medicare Part B Pharmacy and related claims, and ensuring compliance with production goals and quality assurance metrics.
Responsibilities & Expectations
- Assist Members: Address inquiries by phone
- Investigate Issues: Resolve Medicare Part B claims
- Review Documentation: Analyze clinical records
- Ensure Compliance: Meet QA metrics
- Make Determinations: Deliver final decisions
Relevant Experience & Skills Required
- Education Requirements: High school diploma or GED
- Industry Experience: Healthcare or pharmaceutical
- Data Entry Skills: Proficient in MS Office
- Customer Service: 1+ years experience
- Remote Work: Experience in home setting
Compensation & Benefits
The compensation for this role is $43,000 – $56,200/yr..
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Before You Apply: Resume Tips for this ATS
Because you are applying directly through the employer’s Applicant Tracking System, your resume needs to be optimized for their software:
- Make sure the words “Grievances,” “Appeals,” and “Medicare” appear in your past experience if applicable.
- Highlight any specific experience you have with PaHub.
- Ensure your resume clearly states that you are looking for Full-Time work, so the recruiter knows you are aligned with the role.