Become a part of our caring community and help us put health first

As the Claims Research & Resolution Lead, you will manage the full spectrum of claims operations, including customer contact, claim investigation, and settlement for both incoming and outgoing claims. This leadership role is responsible for approving all claim settlements and addressing issues of varying complexity, from moderate to substantial. Your expertise will be essential in ensuring claims are handled efficiently, fairly, and in alignment with organizational standards

Key Responsibilities:

Collaborate with internal iCare/Humana departments to ensure successful project completion.
Engage with insurance companies, providers, members, state and federal regulators, and collection services to facilitate the settlement of claims.
Advise executives and senior leadership by developing functional strategies, often specific to particular segments, on matters of significance.
Analyze large, complex data sets to develop and present strategic recommendations.
Oversee claims research and settlement processes, providing effective team leadership.
Demonstrate an ability to balance business objectives with people management.
Deliver effective presentations to all levels of organizational leadership.

Use your skills to make an impact

Required Qualifications

Bachelor’s degree in Business Administration, Finance, Information Systems, or related field.
Eight (8) or more years of technical experience in healthcare, medical economics, financial analysis, or claims operations.
Two (2) or more years of project leadership or management experience.
Residency in either the State of Wisconsin or Louisville, Kentucky, is required.
Advanced proficiency in SQL, Excel, and Power BI for data analysis and reporting.
Demonstrated ability to analyze large and complex data sets to develop strategic recommendations.
Experience in managing claims research, settlement processes, and providing effective team leadership.
Strong business acumen with excellent presentation and communication skills, including the ability to interact effectively with senior leadership and regulatory agencies.

Preferred Qualifications

Recognized for extraordinary and consistent performance in previous roles.

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: Up to 25%- will be expected to travel as needed for required meetings both in and out of state.
Typical Work Days/Hours: Monday – Friday, 8:00-5:00 pm CST

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 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.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

home:home

Travel: While this is a remote position, occasional travel to Humanas offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.