Claims Processing Representative

About the role

The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The role performs varied activities and moderately complex administrative/operational/customer support assignments. They determine whether to return, deny, or pay claims following organizational policies and procedures.

Responsibilities

• Determines whether to return, deny, or pay claims following organizational policies and procedures.
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing.
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Requirements

• MUST reside within 50 miles of the following Humana location: 101 E. Main St, Louisville, KY 40202.

Qualifications

• Analytical thinking skills and comfortable working independently and with minimal supervision.
• Prior experience working with multiple computer systems at a time and multitasking through those effectively.
• Able to manage multiple or competing priorities, including use of multiple computer applications simultaneously.
• Excellent verbal and written communication skills.
• Proficiency in all Microsoft Office: Word, PowerPoint, Excel.

Preferred Qualifications

• 1+ years of experience within the healthcare and/or insurance industries.
• Customer service experience.
• CAS Claims processing experience.
• Bachelor's Degree.

Skills

• Analytical thinking skills.
• Ability to manage multiple or competing priorities.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office.

Benefits

• 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.
• Many other opportunities.

Pay and Schedule

Compensation range: $40,000 - $52,300 per year. Work Schedule: This position is scheduled to start on Tuesday, September 8th, 2026. IN PERSON training starts day one of employment and will run for 6 weeks with a schedule of 8:00AM-4:30PM Eastern Monday - Friday. After training and appraisal period, associates will transition to Work From Home and required to work a schedule of: 8:00AM-4:30PM Eastern Monday-Friday. The initial 120 days of employment constitute an appraisal period.