Become a part of our caring community and help us put health first
 The Claims Research & Resolution Representative 3 manages claims operations, assisting in processing of corrected claims. The Claims Research & Resolution Representative 3 performs advanced administrative / operational / customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

The Claims Research & Resolution Representative 3 researches resolutions to pending claims. Decisions are typically focused 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, and works under limited guidance due to previous experience / breadth and depth of knowledge of administrative processes and organizational knowledge. The Claims Research & Resolution Representatives will be fully trained on all corrected claims processing and reprocessing.

Use your skills to make an impact
 

Required Qualifications

Although this is a remote position, we require the selected candidates to CURRENTLY reside within a fifty (50) mile radius of one of the following Humana offices:101 E. Main Street, Louisville, KY 402024030 Boy Scout Blvd., Tampa, FL 336072 years CAS claims processing experienceAbility to manage multiple or competing priorities, including use of multiple computer applications simultaneouslyEffective verbal and listening communication skillsCapacity to maintain confidentialityStrong attention to detail

Preferred Qualifications

Prior claims adjustment / reprocessing experienceExperience using CRM technologyIntermediate mathematical skills

Additional Information

Training

Virtual training starts on day one of employment and will run for the first 8 weeks with a schedule of 8:00 AM – 4:30 PM Eastern time, Monday – Friday.For associates who reside within 50 miles of our Louisville, KY offices, training will be held in person at our offices located at 101 E. Main Street, Louisville, KY 40202.Tampa area associates will participate in training remotely.Following training, all associates will work remotely.You must be on time, dressed appropriately / camera ready, with your camera on during training and for other meetings required by leadership.Attendance is vital for your success; no time off will be allowed during training or within your first sixty (60) days.

Work Hours Following 8 Week Training Period

Following training, associates will initially work an 8-hour shift of 8:00 AM – 4:30 PM Eastern, Monday – Friday.Once associates become proficient in the role, they may have the option to bid for a flex shift of 6:00 AM – 2:30 PM, 7:00 AM – 3:30 PM, 8:00 AM - 4:30 PM, or 9:00 AM - 5:30 PM (all times Eastern). Flexible shifts are granted based on performance and business needs.Some overtime may be required, depending on business needs.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 outside the Claims Research & Resolution team. 

Please be sure to include your resume with your application (PDF OR Word format)! 

Interview Process

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

Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.Video Prescreen: If you are successful with the text prescreen, you will receive another 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 jobNote: 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.

Work From Home Guidance:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadership; hot spots are not permitted.Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees 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

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.

 

$43,000 - $56,200 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.

About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.