[Hiring] Claims Review Representative 3 @Humana

Role Description

The Claims Review Representative 3 makes appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Where you Come In:

• Partners with professional staff on pre-screening review by applying guidance and making appropriate decisions, which may include interpretation of provider information or data.
• Decisions typically focus on methods, tactics, and processes for completing administrative tasks/projects.
• Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques.
• Works under limited guidance due to previous experience and breadth and depth of knowledge of claims processes.

Qualifications

• Strong and proven experience with processing and adjudicating medical claims.
• CAS, CIS/CISpro experience.
• Working knowledge of computers or a demonstrated technical aptitude.
• Ability to quickly learn new systems.
• Ability to manage and prioritize tasks based on business need.
• Remote position: 40 hours, 8 hours/day, 5 days per week (Monday-Friday). Occasional overtime may be required.
• Due to contractual requirements, this position is not permitted to perform work in Puerto Rico, Alaska, or Hawaii.

Requirements

• Knowledge of Humana internal systems.
• MTV experience.
• Knowledge with CPT and ICD9 terminology/codes.
• Proficiency in Microsoft Office applications including Word, Excel, and Outlook.

Benefits

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parent Leave.

Work at Home Requirements

• Self-provided internet service must meet the following criteria:
• Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended; wireless, wired cable, or DSL connection suggested.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense.
• Humana will provide telephone equipment appropriate to meet business requirements.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing 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.

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.

$44,900 - $60,200 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.

Application Deadline

05-21-2026

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.