Claims Research & Resolution Rep

About the Team

Humana is a leading U.S. healthcare company dedicated to making it easier for millions of people to achieve their best health. Through our insurance services and CenterWell healthcare services, we deliver the care and service people need when they need it, improving the quality of life for individuals with Medicare and Medicaid, families, and communities. We value associate engagement and well-being, providing excellent professional development and continued education opportunities.

The Claims Research & Resolution team is a group of associates dedicated to researching and resolving pending claims. We work collaboratively with insurance companies, providers, members, and collection services to ensure accurate and timely resolutions for claims and claims-related financial issues.

About the Role

As a Claims Research & Resolution Representative 2, you will join a caring community to manage moderately complex claims operations. This role involves customer contact, investigation, and the resolution of claims or financial issues through semi-routine assignments and intermediate-level math computations.

You will serve as the primary point of contact for inbound calls, addressing complex financial recovery, answering questions, and resolving issues. The role also includes making outbound calls for case follow-ups, recording detailed notes on inquiries and transactions, and escalating unresolved matters. While working within defined parameters and standard policies, you will exercise independent discretion to prioritize tasks and determine the best methods for completing assignments. You will cross-train in all department functions and work with minimal direction to identify work expectations and quality standards.

This is a remote opportunity to utilize your research, resolution, and customer service skills within a Fortune 100 company. While the position is primarily home-based, occasional travel to Humana offices may be required for training or meetings.

Hiring Process

Our hiring process utilizes technology to efficiently connect with candidates and assess relevant skills:

1. Text Prescreen: Shortly after applying, you may receive a text or email with simple yes/no questions.
2. Video Prescreen: Successful candidates will be invited to record a video response using their phone, tablet, or computer.
3. Interviews: Selected candidates will be contacted by a recruiter to schedule an interview.
4. Offer: Finalists will be contacted to discuss the job offer.

Please note that the process may take several weeks depending on the volume of applications and interviewer schedules. Ensure you attach your resume (PDF or Word format) to your application.

Work Schedule and Training

This role requires a commitment to a specific training and work schedule. Virtual training begins on day one and runs for up to 8 weeks, Monday through Friday, from 8:00 AM to 4:30 PM Eastern Time. Attendance is vital during this period, and no time off is allowed. The initial 180 days of employment serve as an appraisal period essential for your learning and development.

Following training, you must be willing to remain in this position for 18 months before applying to other Humana opportunities. Post-training work hours are an assigned 8-hour shift between 8:00 AM and 6:00 PM Eastern Time, with potential overtime based on business needs.

Work at Home Guidance

To ensure effective remote work, associates must meet specific internet criteria (minimum 25 Mbps download / 10 Mbps upload). Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses. Humana provides necessary telephone equipment, and associates must work from a dedicated, interruption-free space to protect member PHI/HIPAA information.

Equal Opportunity Employer

Humana is an Equal Opportunity Employer. It is our policy not to discriminate against any employee or applicant for employment based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We take affirmative action to employ and advance individuals with disabilities or protected veteran status and base all employment decisions only on valid job requirements.