[Hiring] Claims Processing Representative @Humana

Role Description

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 various activities and moderately complex administrative, operational, and customer support assignments. Perform computations and work on semi-routine assignments.

• 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.

Qualifications

• MUST reside in the state of Kentucky, Indiana, Florida, or Wisconsin.
• 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.

Requirements

• Bachelor's Degree (Preferred).
• Quality background (Preferred).
• CAS Claims processing experience (Preferred).

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; no time off is allowed during training except for Humana-observed holidays.
• 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; perfect attendance is required 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 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

• Minimum download speed of 25 Mbps and 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.

Interview Process

• As part of our hiring process, we will use technology called HireVue to enhance our hiring.
• You will receive communication to record a Video Prescreen.
• Some candidates will be invited to interview; if so, the recruiter will reach out to schedule.
• Finalists from the interview will be contacted by a recruiter to discuss an offer for the job.

Scheduled Weekly Hours

• 40 hours per week.

Pay Range

• $40,000 - $52,300 per year.

Benefits

• 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.