Claims Processing Representative

Overview The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. Performs varied activities and moderately complex administrative/operational/customer support assignments, including computations. Works on semi-routine assignments and determines whether to return, deny, or pay claims following organizational policies and procedures. Focuses on interpretation of area/department policy and methods for completing assignments while working within defined parameters and exercising independent discretion. Responsibilities Review and adjudicate complex or specialty claims via paper or electronically. Perform computations and related administrative tasks. Determine if claims should be returned, denied, or paid based on policies. Interpret department policy and apply guidelines with minimal supervision. Required Qualifications Analytical thinking skills and comfortable working independently and with minimal supervision. Prior experience working with multiple computer systems at a time and multitasking through them effectively. Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously. Excellent verbal and written communication skills. Proficiency in all Microsoft Office: Word, PowerPoint, Excel. Preferred Qualifications 1+ years of experience within the healthcare and/or insurance industries. Customer service experience. Passion for contributing to an organization focused on continuously improving consumer experiences. CAS Claims processing experience. Bachelor's Degree. Required Work Schedule Training: This position is scheduled to start on Tuesday, September 8th, 2026. IN PERSON training starts day one of employment and will run for 6 weeks with a schedule of 8:00AM-4:30PM Eastern Monday - Friday. Work Schedule Following Training: Following training and appraisal period, associates will transition to Work From Home and required to work a schedule of: 8:00AM-4:30PM Eastern Monday-Friday. The initial 120 days of employment constitute an appraisal period. This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods. The department has a strict attendance policy. Time off is not permitted during the first 90 days and is discouraged during the 120-day appraisal period. This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities. Weekly Hours 40 hours per week Pay Range The compensation range reflects an 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. $40,000 - $52,300 per year 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. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our #J-18808-Ljbffr