Claims Processing Professional

Humana • Miramar, OH

1d • $53,700 - $72,600 • Onsite

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree