Inbound Contacts Representative in Nationwide

Become a part of our caring community Humana is looking for Inbound Contacts Representatives to be a part of our Provider Call Center; you are often the first human connection our members have with us. Working remotely, you will report to the Inbound Contacts Supervisor and be a part of the Medicare team. Every interaction is an opportunity to solve a problem, reduce frustration, and create trust. You will support members and providers by answering benefit questions, resolving concerns, and guiding them through next steps, helping ensure they feel informed and supported. This role is ideal for someone who enjoys helping others and takes pride in delivering a high-quality customer experience. As an Inbound Contacts Representative 2, you will: Handle 40+ inbound calls daily from providers in a back-to-back call center environment Address multiple members and provider needs, including benefit questions, service issues, and general inquiries Escalate unresolved and pending customer grievances Document all interactions, actions taken, and outcomes in internal systems Resolve routine to moderately complex issues by following established guidelines and workflows Identify issues requiring escalation and ensure handoff to the appropriate teams Meet quality, productivity, and customer experience expectations What Success Is: Providers feel heard, supported, and satisfied with their experience You are proactive and resolve issues on the first contact whenever possible Documentation is complete, clear, and compliant Experience empathizing with frustrated customers, and accountability in every interaction Use your skills to make an impact Required: 2+ years of Customer Service experie

Become a part of our caring community The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Inbound Contacts Representative serves as a primary point of contact for customers, providing support through phone, digital, and written channels. This role handles a variety of customer inquiries, resolves issues, and delivers accurate information while ensuring a positive customer experience. The position performs moderately complex customer service, administrative, and operational support activities, manages semi-routine assignments with minimal guidance, and exercises sound judgment to support quality service and customer satisfaction. As an Inbound Contacts Representative, you will: Respond to customer inquiries by phone, digital, or written channels, including benefits questions, issue resolution, and member education. Accurately document customer interactions, requests, concerns, and resolutions in applicable systems. Research and resolve customer issues, escalating complex or unresolved matters as appropriate. Apply established policies, procedures, and resources to deliver accurate and timely support. Use critical thinking and sound judgment to address customer needs and recommend solutions. Manage workload effectively, prioritize tasks, and meet quality and service expectations. Work independently within established guidelines while supporting customer satisfaction and business objectives. Use your skills to make an impact Required Qualifications 3

Become a part of our caring community As a Care Management Support Assistant, you will help members take the next step toward better health and well-being. You will do this by connecting with them over the phone, completing important non-clinical assessments, identifying barriers to care, and helping them access resources and benefits. We are looking for people who show compassion and document customer issues in detail, can work in a call center environment, and motivate themselves through work that directly supports members and care teams. This is a remote position, and the assigned shift will be 11:30 AM–8:00 PM Eastern Standard Time. Job Description What You Will Do Engage members by phone to encourage participation in care management programs. Complete required assessments and questionnaires to help identify health risks, care needs, and opportunities for clinical team follow-up. Assist members who need support scheduling doctor’s appointments or connecting with appropriate care resources. Identify and help address barriers to preventive screenings, benefits, and health-related services so members can close gaps in care. Support members in understanding, retaining, and accessing benefits that contribute to their overall health and well-being. Manage both inbound and outbound calls in an auto-dialer environment while documenting member information. What Success Looks Like You create a positive member experience by treating each interaction with respect, patience, and professionalism You demonstrate compassion, integrity, and sound judgment when supporting members with sensitive health-related needs You listen to

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1+ year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi