Claims Processing Representative 1

Become a part of our caring community and help us put health first
 The Claims Processing Representative 1 reviews and adjudicates complex or specialty claims, submitted via paper. The Claims Processing Representative 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments.

Where you Come In 
The Claims Processing Representative 1 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.

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 

• Proficiency in all Microsoft Office Programs including Word, PowerPoint, Excel, and Access

• Experience in a fast paced, metric driven operational setting

• Previous experience with coordinating and leading projects and tasks

• Demonstrated capability with coaching and developing associates formally and informally

• Capacity to maintain confidentiality

• Ability to use multiple systems and strong attention to detail

• Requires a high level of problem-solving and analytical skills

• Ability to manage and prioritize multiple task initiative

• Proficient verbal and written communication

Preferred Qualifications

• CAS claims processing experience

• CIS pro and CIS experience

• Medicare experience

• CMS experience

Additional Information - How we Value You
•    Benefits starting day 1 of employment 
•    Competitive 401k match  
•    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

·             Associates 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 associates 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

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.

 

$39,000 - $49,400 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.

Application Deadline: 01-28-2026
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.

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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 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.