Claims Processing Representative 2 at Humana

Louisville, Kentucky, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

MUST reside within 50 miles of 101 E. Main St, Louisville, KY 40202
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
Ability 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
Willing to start on January 26th, 2026, with 6 weeks of in-person training (8:00AM-4:30PM Eastern, Monday-Friday) and perfect attendance during initial 120-day appraisal period
Strict adherence to attendance policy (no time off in first 90 days, discouraged during 120-day period)
Willing to remain in position for 12 months before applying to other Humana opportunities
Self-provided internet meeting minimum speeds (25 Mbps download, 10 Mbps upload), hard-wired connection (no wireless, satellite, cellular, or microwave)
Work from a dedicated space lacking ongoing interruptions to protect PHI/HIPAA information

Responsibilities

Reviews and adjudicates complex or specialty claims submitted via paper or electronically
Performs varied activities and moderately complex administrative/operational/customer support assignments
Performs computations
Determines whether to return, deny, or pay claims following organizational policies and procedures
Interprets area/department policy and methods for completing assignments
Works within defined parameters to identify work expectations and quality standards, with some latitude over prioritization/timing under minimal direction
Follows standard policies/practices with opportunity for interpretation/deviation and independent discretion
Works 8:00AM-4:30PM Eastern, Monday-Friday after training (transition to work from home)

Skills

Analytical Thinking

Multitasking

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Claims Processing

Claims Adjudication

Verbal Communication

Written Communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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