Claims Processing Representative

Claims Processing Representative

The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

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 those 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
• Must be passionate about 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.

Interview Process

As part of our hiring process for this opportunity, we will be using technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

• Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 5-10 prescreen questions.
• Video Prescreen: You will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer.
• 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 $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, 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.