{"id":2099366,"url":"https://alion.io/job/humana-claims-research-resolution-rep","title":"Claims Research Resolution Rep","company":{"id":2742,"name":"Humana","domain":"humana.com","url":"https://alion.io/company/humana","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"A","score":98,"open_postings":81,"ghost_share":0.025,"stale_share":0.111,"repost_share":0.21,"time_to_fill_p50_days":10,"computed_at":"2026-10-20T05:45:00Z"}},"role":"Customer Success","role_family":"Customer Success","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":{"label":"EST","utc_offset_min":-5,"utc_offset_max":-5},"hiring_geo_confidence":"structured","locations":["Washington, United States","New York, United States","United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":null,"salary_estimate":{"min_usd":31000,"max_usd":61000,"period":"year","method":"role_seniority_country_remote_cell","sample_n":274},"experience_years_min":1,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Excel","optional":false},{"name":"HIPAA","optional":true}],"status":"live","first_seen_at":"2026-10-08T17:50:33Z","employer_posted_date":"2026-10-08","last_verified_at":"2026-10-18T16:53:04Z","board_verified":false,"closed_at":null,"days_open":12,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":12},"description":"Become a part of our caring community\nThe Claims Research & Resolution Representative 3 manages claims operations that involve customer contact, investigation, and settlement of claims for and against our organization. You will report the Supervisor, Claims & Research Resolution.As the Claims Research & Resolution Representative 3 you will\nWork with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.\nUse in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards. \nCollaborate with specialized team of claims, call center, and provider associates to research pending claims issues. \nApply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects. \nDemonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries. \nPivot quickly from one project to the next, based on business needs, with the ability to experience handling support requests from a variety of different channels, based on inventory load\nUse your skills to make an impact\nRequired Qualifications\n1 or more years of Healthcare customer service experience\n1 or more years of call center experience\nIntermediate Excel skills\nIntermediate proficiency Word\nWorking knowledge of healthcare terminology\nWorking knowledge of Medicare or Medicaid claims\nPreferred Qualifications\nHealthcare call center experience\nWorking knowledge with Microsoft Access\nMedical claims processing experience\nMember reimbursement experience\nMedicare industry\nHealthcare Benefit knowledge\nRequired Work Schedule:\nTraining you will:\nVirtual training and runs for 8 weeks with a schedule of Monday - Friday, 8:00am - 4:30pm EST.\nAttendance is vital for success; other than Humana-observed holidays, no time off is allowed during training or during your first 120 days of employment.\nYou must be on time, dressed appropriately, with your camera ON for the entire duration of training, nesting, and for other meetings required by leadership.\nAfter Training you will:\nFollowing training, you must be able to workanyshift Monday - Friday, between the hours of 6:00am - 5:30pm EST.\nYou will learn many systems, policies, and tools, and it takes times to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities outside of this team.\nRequires an 18 month time in job commitment\nWork at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours\n40Pay Range\nThe 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.$43,000 - $56,200 per yearDescription of Benefits\nHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About us\nAbout Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer\nIt 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.","description_format":"text","description_chars":5872,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"phd","optional":false},"security_clearance":false,"languages":[]},"benefits":["Life insurance","Retirement plans"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Home Care Services","Primary Care & Medical Centers","Pharmacies","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-08T17:50:33Z"}],"visa":[{"country":"US","licensed_sponsor":true,"evidence":"H-1B filings in 12 months: 339 · green card filings: 89","filings_12m":339,"filings_prev_12m":256,"green_card_filings_12m":89,"median_offered_wage_usd":137500,"route":null,"cap_exempt":false,"checked_at":"2026-10-15T11:24:14+00:00","sources":["US Department of Labor: LCA disclosure data (H-1B, H-1B1, E-3)","US Department of Labor: PERM disclosure data (green cards)"],"filings_for_role_12m":0}],"liveness":{"score":31,"band":"fade","label":"Fading","p_open":1,"p_active":0.572,"p_room":0.55,"age_days":11,"expected_fill_days":10,"reasons":["conf:36","velocity","win:tail","comp:junior,brand"],"computed_at":"2026-10-20T05:45:00Z"},"pay":null,"html_url":"https://alion.io/job/humana-claims-research-resolution-rep","json_url":"https://alion.io/job/humana-claims-research-resolution-rep.json","meta":{"generated_at":"2026-10-20T18:37:42Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":21458,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-21T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":2742},"rest":"https://alion.io/mcp/rest/get_company?id=2742"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fhumana-claims-research-resolution-rep"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fhumana-claims-research-resolution-rep"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fhumana-claims-research-resolution-rep"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/humana-claims-research-resolution-rep\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fhumana-claims-research-resolution-rep"}]}