Claims Processing Professional

Become a part of our caring community as a Claims Processing Professional. You'll review healthcare claims to help ensure their accuracy by verifying claim information, eligibility, authorizations, and provider contracts, and determining appropriate claim outcomes while following established policies and regulatory guidelines.

About the role

In this in-office position reporting to the Enterprise Transformation Director, you'll collaborate with other teams, navigate multiple systems, and help deliver claim resolutions that support a positive experience for providers and members.

Responsibilities

• Review and process healthcare claims within established turnaround times.
• Verify member eligibility, provider information, authorizations, and contractual requirements before processing claims.
• Determine whether to approve, deny, adjust, or return claims for additional information.
• Resolve claim discrepancies by gathering and evaluating supporting documentation.
• Process both electronic and paper claims while maintaining productivity, quality, and accuracy standards.
• Use multiple internal systems to review claims, document findings, and complete claim processing.
• Maintain compliance with HIPAA regulations, organizational policies, and all applicable state and federal guidelines.
• Collaborate with internal departments to resolve claim issues and support claim adjudication.
• Adapt to evolving business processes, system enhancements, and regulatory changes.
• Meet productivity, quality, and performance expectations.

Requirements

• Minimum of 1 year of healthcare claims processing experience.
• Knowledge of healthcare claims processing practices and medical insurance terminology.
• Ability to work across multiple computer systems.
• Ability to prioritize multiple tasks and work independently.
• Commitment to HIPAA compliance.

Qualifications

Preferred qualifications include:

• Experience processing medical, home health, or managed care claims.
• Knowledge of CPT, ICD-10, and HCPCS coding.
• Experience working with provider contracts, authorizations, or eligibility verification.
• Bilingual (English/Spanish).
• Associate's degree or higher in Business, Healthcare Administration, or a related field.

Schedule

Scheduled weekly hours: 40

Pay

The pay range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The range may vary based on geographic location and individual pay will depend on demonstrated job-related skills, knowledge, experience, education, and certifications.

$53,700 - $72,600 per year

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off, including paid time off, company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

About Us

About OneHome: OneHome coordinates a full range of post-acute care, including home health, infusion therapy, and durable medical equipment services at patients’ homes. OneHome’s patient-focused model creates one integrated point of accountability that coordinates with physicians, hospitals, and health plans, serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health. Learn more at Humana.com and CenterWell.com.

Our culture is inclusive, diverse, and above all, caring. We ensure our employees are engaged, supported, and fairly treated, offering a comprehensive benefits package to ensure health and financial well-being for you and your family.