[Hiring] Grievances & Appeals Lead @Humana

Role Description

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.

• 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

Qualifications

• 7+ years in healthcare operations, compliance, process improvement, project management or related field
• 1+ year of Medicare Grievances experience
• 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

Requirements

• 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 (English and Spanish); with the ability to read, write, and speak English and Spanish
• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps; dedicated workspace to protect member PHI / HIPAA information
• Travel: Occasional travel to Humana's offices for training or meetings may be required

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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.