Claims Research and Resolution Representative

Become a part of our caring community and help us put health first

Join Humana’s dynamic team as a Claims Research & Resolution Representative and make a meaningful impact every day! In this vital role, you’ll be at the heart of our claims operations—connecting with providers and members to resolve and settle claims that shape the health industry. You’ll leverage your expertise and independent judgment to investigate cases, approve settlements, and navigate complex administrative challenges.

This position offers the opportunity to collaborate with dedicated associates, exercise your problem‑solving skills, and play a key role in driving operational excellence. If you thrive in a fast‑paced environment and enjoy making decisions that matter, Humana invites you to bring your initiative and experience to our mission‑driven team.

• Works with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Comprised of a group of calls/claims/provider associates researching the resolution to a pending call.
• 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.
• Demonstrates a high level of autonomy, leveraging experience and organizational knowledge to resolve claims inquiries.

• 2+ years of customer service and/or claims experience.
• Proficient in Microsoft Office applications (Outlook, Word, Teams, Excel).
• Capacity to maintain confidentiality.
• Knowledge of healthcare terminology.

• Medical claims processing experience.

• Workstyle:
  Remote, work from home.
• Required work schedule:
  Monday – Friday, 8:00 am – 4:30 pm Eastern Time Zone (EST).
• Travel:
  While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

$43,000 - $56,200 per year

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 advance in employment individuals with 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our