Grievances & Appeals Lead

Become a part of our caring community   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. As the Grievances & Appeals Lead, you will: • 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 Use your skills to make an impact   Required 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 Preferred Qualifications • 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: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   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.   $86,300 - $118,700 per year   This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 11-06-2026 About us   About Humana: 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