Job Description
Become a part of our caring community and help us put health first
The Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
Where you Come In
The Claims Review Representative partners with professional staff on pre-screening review by applying guidance and making an appropriate decision which may include interpretation of provider information or data. 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.
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Use your skills to make an impact
Required Qualifications – What it takes to Succeed
High School Diploma or equivalent.
Minimum of two years’ proven experience in processing and adjudicating medical claims, with a track record of accurate and timely claim review completion.
Proven ability to maintain confidentiality and handle sensitive information in compliance with organizational policies and applicable regulations.
Solid understanding of medical coding terminology, including CPT, ICD-9, and ICD-10 codes.
Proficient in Microsoft Office applications, specifically Word, Excel, and Outlook, to effectively manage documentation and communications.
Exceptional attention to detail and accuracy in reviewing and processing claims.
Ability to quickly adapt to and learn new systems and technologies relevant to claims processing.
Strong organizational skills with the capacity to manage and prioritize multiple tasks based on business needs.
Bilingual fluency in English and Spanish
Preferred Qualifications:
Associate or bachelor’s Degree.
Previous experience with CAS claims systems.
CIS/CIS Pro experience
Foundational knowledge of finance principles related to claims processing.
Additional Information - How we Value You
Benefits starting day 1 of employment
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Work at Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 suggested
Satellite, cellular and microwave connection can be used only if approved by leadership.
Work from a dedicated space lacking ongoing interruptions to protect member PHI /HIPAA information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$35,900 - $48,200 per year
The Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
Where you Come In
The Claims Review Representative partners with professional staff on pre-screening review by applying guidance and making an appropriate decision which may include interpretation of provider information or data. 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.
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Use your skills to make an impact
Required Qualifications – What it takes to Succeed
High School Diploma or equivalent.
Minimum of two years’ proven experience in processing and adjudicating medical claims, with a track record of accurate and timely claim review completion.
Proven ability to maintain confidentiality and handle sensitive information in compliance with organizational policies and applicable regulations.
Solid understanding of medical coding terminology, including CPT, ICD-9, and ICD-10 codes.
Proficient in Microsoft Office applications, specifically Word, Excel, and Outlook, to effectively manage documentation and communications.
Exceptional attention to detail and accuracy in reviewing and processing claims.
Ability to quickly adapt to and learn new systems and technologies relevant to claims processing.
Strong organizational skills with the capacity to manage and prioritize multiple tasks based on business needs.
Bilingual fluency in English and Spanish
Preferred Qualifications:
Associate or bachelor’s Degree.
Previous experience with CAS claims systems.
CIS/CIS Pro experience
Foundational knowledge of finance principles related to claims processing.
Additional Information - How we Value You
Benefits starting day 1 of employment
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Work at Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 suggested
Satellite, cellular and microwave connection can be used only if approved by leadership.
Work from a dedicated space lacking ongoing interruptions to protect member PHI /HIPAA information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$35,900 - $48,200 per year
💡 Quick Summary
Seeking a career-building opportunity? The Claims Review Representative position is now open for candidates interested in the Work from home Jobs sector. This role in Baker offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.