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Humana

Claims Research & Resolution Professional Physical Health

3+ months agoOklahoma City, OK / Remote

Become a part of our caring community and help us put health first


Humana Healthy Horizons in Oklahoma is seeking a Claims Research & Resolution Professional 2 (Physical Health) who manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We're proud of our Louisville roots and, as we've grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are-whether you're working from home, from the field, from our offices, or from somewhere in between-you'll feel welcome here. We're a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone's voice is heard and respected. Community is a verb here. It's up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.



Are you Caring, Curious and Committed? If so, apply today!

The Claims Research & Resolution Professional 2

  • Works with insurance companies, PCP and other medical providers, members, and collection services in the settlement of claims
  • Comprised of a group of calls/claims/provider associates researching the resolution to a pending call
  • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where neede
  • Follows established guidelines/procedures


Use your skills to make an impact


Required Qualifications

  • Must reside in Oklahoma
  • 1-5 years of technical experience in Claims Research & Resolution within the healthcare industry
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Master's Degree

Additional Information

About Humana

Your growth is what drives Humana forward.

  • When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don't grow without you
  • This is a place where our nurses influence the C-suite
  • Where software engineers change lives
  • Where every associate can build a professional path where they learn and thrive
  • Through our commitments to wellbeing and work-life balance, we support each associate's personal health, purpose, work style, sense of belonging, and security
  • Because finding new ways to put health first-for our members and patients and our associates alike-is what we do

Work at Home Guidance

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, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40


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.

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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Client-provided location(s): Oklahoma City, OK, USA; Fort Sill, OK, USA
Job ID: humana-R-323476
Employment Type: Full Time