Manager, Claims Research & Resolution

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. Are you ready to lead and make a real impact? Join us as our Manager, Claims Research & Resolution—a key leadership role where you’ll drive critical claims operations, oversee complex investigations, and ensure fair settlements for and against our organization. In this dynamic position, you’ll leverage your advanced technical expertise to solve challenging problems, guide a dedicated team, and shape the future of our claims process. You’ll have the autonomy to set objectives, manage resources, and achieve organizational goals, all while working within established guidelines to deliver outstanding results. Step into a role where your leadership and vision truly matter—apply today and help us set the standard for excellence in claims management.

Key Responsibilities

• Oversee the end-to-end claims research and resolution process, ensuring accuracy, efficiency, and compliance with organizational policies and regulatory guidelines.
• Lead, coach, and develop a dedicated team of claims professionals, fostering a collaborative and high-performance environment.
• Manage and resolve complex and escalated claims cases, leveraging your technical knowledge and sound judgment.
• Ensure fair settlements for and against the organization, making decisions that balance organizational goals with customer satisfaction.
• Set clear objectives, manage resources, and monitor progress toward departmental and organizational goals.
• Collaborate with cross-functional teams and stakeholders to enhance claims processes and implement best practices.
• Analyze claims data and metrics to identify trends, drive process improvements, and optimize operational performance.
• Maintain up-to-date knowledge of industry regulations, trends, and technologies to ensure continuous improvement and compliance.
• Responsible for maintaining the appropriate staff levels within your area, while maintaining the budget for the calendar year.

Note: There are 2 open positions - one will support the Claims Research Unit (CRU) and the other supports the Macess Corrected Claims team. Use your skills to make an impact.

Required Qualifications

• Bachelor's Degree, or in lieu of, 5 or more years of management experience
• 3-5 years of claims experience
• 3 or more years of inventory management experience
• Effective presentation and written/oral communication skills
• Proficiency in Microsoft Office applications
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Claims rework experience
• CAS experience

Additional Information

Workstyle: Home: Associates Home office environment is their primary work location, but they will use Humana office space on an as needed basis for collaboration and other face-to-face needs. Travel: 10% - attend strategy sessions Typical Workdays/Hours: Monday – Friday, 8:00 am – 5:00 pm EST, with some flexibility as needed

WAH Internet Statement: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

HireVue: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue