Claims Processing Representative

Become a part of our caring community The Medicare Initial Claims team is looking for Claims Processing Representatives. You will review and adjudicate complex or specialty claims, submitted either by paper or electronically. Reporting to the aligned Supervisor as a Claims Processing Representative 2 you will perform varies activities and moderately complex administrative, operational, and customer support assignments. Perform computations and work on semi-routine assignments. As a Claims Processing Representative 2 you will: Determine whether to return, deny, or pay claims following organizational policies and procedures. Make decisions that typically focus on interpretation of department policy and methods for completing assignments. Work within defined parameters to identify work expectations and quality standards. Be a part of a metric based environment. Follow standard policies that allow for some opportunity for interpretation and independent discretion. Use your skills to make an impact Required Qualifications: MUST reside in the state of Kentucky, Indiana, Florida, or Wiscision 1+ years of technical experience and/or customer service-related field Prior experience working with multiple computer systems at a time and multitasking through those. Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously. Proficiency in all Microsoft Office: Word, PowerPoint, Excel Preferred Qualifications: Bachelor's Degree Quality background CAS Claims processing experience Required Work Schedule: Training: The start date for this position is Monday July 27th, 2026. Virtual training starts day one and will run for up to 8 weeks with a schedule of 8:00 AM to 4:30 PM Eastern Time, Monday – Friday. Attendance is vital for success; other than Humana-observed holidays, no time off is allowed during training. Post Training: Following training, associates will work 8:00 AM to 4:30 PM Eastern Time, Monday – Friday. Must be willing to work overtime, based on business needs. The initial 120 days of employment constitute an appraisal period. This Appraisal Period is necessary 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. You will learn 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 outside of this team. Remote Work at Home Requirements To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended. Associates in this role are required to be hard-wired with their internet connection. Wireless, satellite, cellular and microwave connections are not permitted. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Additional Information **PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT)** This position is scheduled to start on Monday, July 27th, 2026 We are only considering candidates who reside in the state of Kentucky, Indiana, Florida, or Wiscision Interview Process As part of our hiring process for this opportunity, we will use technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule. Video Prescreen: You will receive communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet. Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule. Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job NOTE: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed. 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. $40,000 - $52,300 per year 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 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.