Job Overview
Location
Remote Nationwide
Job Type
Full-time
Category
Operations
Date Posted
May 20, 2026
Full Job Description
đź“‹ Description
- • The Claims Review Representative 3 makes appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, and state and federal legislation, playing a critical role in ensuring accurate and compliant claims processing for Humana’s members.
- • Day-to-day responsibilities include performing advanced administrative and operational duties, partnering with professional staff on pre-screening reviews, interpreting provider information or data, exercising discretion and judgment in prioritizing requests, and adapting procedures under limited guidance due to prior experience.
- • The role is part of Humana Inc., a Fortune 100 healthcare company dedicated to improving health outcomes for millions through its insurance and CenterWell services, with a strong commitment to associate well-being, professional development, and inclusive workplace practices.
- • In this role, the individual can deepen expertise in medical claims adjudication, enhance technical proficiency with claims systems, develop advanced decision-making and prioritization skills, and gain exposure to federal and state healthcare regulations—positioning them for growth within Humana’s operations and healthcare administration teams.
🎯 Requirements
- • Strong and proven experience with processing and adjudicating medical claims
- • CAS, CIS/CISpro experience
- • Working knowledge of computers or demonstrated technical aptitude
- • Ability to quickly learn new systems
- • Ability to manage and prioritize tasks based on business need
- • Remote position requiring 40 hours/week, 8 hours/day, 5 days per week (Monday-Friday), with occasional overtime
🏖️ Benefits
- • Benefits starting day 1 of employment
- • Competitive 401(k) match
- • Generous Paid Time Off accrual
- • Tuition Reimbursement
- • Parent Leave
- • Humana provides telephone equipment for remote work and may provide bi-weekly internet stipends for eligible states (CA, IL, MT, SD)
Skills & Technologies
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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