Claims Review Representative

Claims Review Representative

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The Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative / operational / customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

The Claims Review Representative partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks / projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience / breadth and depth of knowledge of administrative processes and organizational knowledge.

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

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 :

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.