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Humana

Claims Research & Resolution Representative

Humana

. Resolve complex medical claims for providers, members, and third-party collection services .

Posted 10/9/2026full-timeRemote • United StatesJunior💰 $34,400 - $45,000 per yearWebsite

Core Competencies

Role fit
Core Competencies

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Demonstrates expertise in resolving complex medical claims while ensuring compliance with regulatory standards and internal policies. Proficient in effective communication in English and knowledgeable in healthcare terminology, with a strong focus on collaboration and problem-solving.

Highest-signal resume keywords
Claims Processing ExperienceCustomer Service ExperienceHealthcare Terminology KnowledgeEffective Communication in EnglishCompliance with PHI/HIPAA Standards

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Claims ResolutionDocumentation VerificationDiscrepancy InvestigationAdministrative Task ManagementRegulatory Compliance
Soft Skills
Judgment and DiscretionCollaborationAutonomous Problem Solving
Tools & Technologies
Internet Service with Minimum 25 Mbps DownloadDedicated Workspace
Certifications & Qualifications
Language Proficiency Assessment
Industry Keywords
Medical ClaimsHealthcarePHIHIPAAClaims Inquiries

About the role

Key responsibilities & impact
  • Resolve complex medical claims for providers, members, and third-party collection services
  • Investigate claims discrepancies and verify documentation
  • Ensure compliance with internal policies and regulatory standards
  • Collaborate with claims, call center, and provider associates on pending claims issues
  • Apply judgment and discretion to determine methods, strategies, and workflows for administrative tasks and projects
  • Resolve claims inquiries autonomously
  • Attend required virtual training and post-training support
  • Work a 40-hour weekly schedule within specified Eastern Time hours

Requirements

What you’ll need
  • Must currently reside in Puerto Rico
  • 1+ years of claims OR customer service experience
  • Must communicate effectively in English, including speaking, reading, and writing
  • Must complete a language proficiency assessment if selected
  • Knowledge of healthcare terminology preferred
  • Prior claims processing experience preferred
  • Must attend virtual training Monday through Friday, 8:00 am–5:00 pm Eastern Time for approximately 8 weeks
  • No time off allowed during training or the first 120 days
  • Must work Monday through Friday between 6:00 am and 5:30 pm Eastern after training and post-training support
  • Must remain in the position for 18 months before applying to other Humana opportunities
  • Internet service with minimum 25 Mbps download and 10 Mbps upload speeds
  • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • 401(k) retirement savings plan
  • Paid time off
  • Company holidays
  • Personal holidays
  • Paid parental leave
  • Paid caregiver leave
  • Short-term disability
  • Long-term disability
  • Life insurance
  • Personal wellness support
  • Smart healthcare decision support
  • Occasional travel to Humana offices for training or meetings may be required