Grievances & Appeals Lead

Humana

2d•$86,300 - $118,700•Remote

About The Position

The Grievances & Appeals Lead supports the Medicare Grievance organization by coordinating Issue of Performance (IOP) oversight, driving corrective actions, supporting CMS audit readiness, and helping reduce compliance risk while advancing quality goals. The role leads IOP identification, monitoring, trending, and reporting across grievance teams; coordinates corrective action plans and remediation; and partners with operational leaders to resolve risks promptly. It also supports CMS audit readiness through documentation, reporting, and governance routines, oversees compliance-related performance metrics and emerging operational risks, and advises executives on strategies related to quality, compliance, and grievance operations. This is a remote position with occasional travel to Humana offices for training or meetings. Employees working from home or a hybrid home/office setting must have an internet connection with at least 25 Mbps download and 10 Mbps upload speed and a dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information. The position is scheduled for 40 hours per week. The listed annual base-pay range is $86,300–$118,700, and the role is eligible for a bonus incentive plan.

Requirements

7 or more years in healthcare operations, compliance, process improvement, project management, or a related field.
At least 1 year of Medicare Grievances experience.
At least 2 years of project leadership experience.
Advanced experience with reporting and Power BI.
Experience analyzing data, identifying trends and root causes, and supporting remediation efforts.
For home or hybrid home/office employees, self-provided internet service must provide at least 25 Mbps download and 10 Mbps upload speed.
For home or hybrid home/office employees, work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Lean or Six Sigma certification.
CMS program audit experience.
Knowledge of Microsoft Access or experience with SQL Server databases.
Experience using data and AI-driven insights to support process improvement and metric remediation.
Bilingual in English and Spanish, with the ability to read, write, and speak both languages.

Responsibilities

Lead IOP identification, monitoring, trending, and reporting across grievance teams.
Coordinate corrective action plans and remediation efforts.
Partner with operational leaders to resolve identified risks promptly.
Support CMS audit readiness activities, including documentation, reporting, and governance routines.
Oversee compliance-related performance metrics and emerging operational risks.
Advise executives on functional strategies related to quality, compliance, and grievance operations.