Humana · 1 day ago
Claims Review Representative
United States
Full-time
Remote
Entry, Mid Level
$45K/yr - $60K/yr
2+ years expHumana Inc. is committed to putting health first for its teammates and customers. The Claims Review Representative is responsible for making appropriate claim decisions based on knowledge of claims procedures and relevant legislation, while performing advanced administrative support duties.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Make appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation
Perform advanced administrative/operational/customer support duties that require independent initiative and judgment
Partner with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data
Regularly exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and work under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge
Qualification
Required
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
Preferred
Associate or bachelor's Degree
Previous experience with CAS claims systems
Foundational knowledge of finance principles related to claims processing
Benefits
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Nwando Olayiwola
Chief Health Equity Officer & Senior Vice President
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase