Claims Processing Professional

About this role

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

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. If you enjoy making an impact behind the scenes, we'd love to have you on our team.

As a Claims Processing Professional, you will: • Review and process healthcare claims within established turnaround times. • Verify member eligibility, provider information, authorizations, and contractual requirements before processing claims. • Determine whether you should 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.

Use your skills to make an impact   Required Qualifications • Minimum of 1 year of healthcare claims processing experience . • Knowledge of healthcare claims processing practices and medical insurance terminology. • Work across multiple computer systems. • Prioritize multiple tasks and work independently. • Commitment to HIPAA compliance.

Preferred Qualifications • 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.

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.   $53,700 - $72,600 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us   About OneHome: OneHome coordinates a full range of post-acute care ranging from 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. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

Similar jobs

• Claims Coordinator — Dutch Bros · 1930 W Rio Salado Pkwy Tempe AZ 85281
• Claims Coordinator — Cottinghambutlerinsuranceservicesinc · Dubuque, Iowa, United States
• Claims Management Analyst — AIG · TX-Dallas | GA-Atlanta
• Claims Process Documentation & Training Specialist — Centivo · Remote
• Claims Submission Rep — Camping World · West Allis, WI
• Claims Manager - Complex Claims Unit — Thehartford · Remote
• Claims Administrator — Cottinghambutlerinsuranceservicesinc · Dubuque, Iowa, United States
• Claims Coordinator, PSA — Collectors · Santa Ana, CA