Claims Research & Resolution Representative

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The Claims Research & Resolution Representative 3 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. 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 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Decisions are 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, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

• 1+ years of call center or related customer service experience
• Capacity to maintain confidentiality
• Must reside in the United States

• Bachelor's Degree
• Prior claims processing experience
• Knowledge of healthcare terminology

• Virtual training tentatively starts on Monday, August 24th, 2026, and runs for 8 weeks with a schedule of Monday – Friday, 8:00am – 4:30pm EST.
• Attendance is vital for success; other than Humana-observed holidays, no time off is allowed during training or during your first 90 days of employment.
• You must be on time, dressed appropriately, with your camera ON for the entire duration of training, nesting, and for other meetings required by leadership.

• Following training, you must be able to work any shift Monday – Friday, between the hours of 6:00am – 5:30pm EST.
• You will learn many systems, policies, and tools, and it takes times to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities outside of this team.

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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$43,000 - $56,200 per year

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.

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.

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