Humana · 17 hours ago
Claims Processing Representative
Miramar, FL
Full-time
Onsite
New Grad, Entry Level
$39K/yr - $49K/yrHumana is a leading healthcare company focused on providing health solutions. The Claims Processing Representative reviews and adjudicates complex claims, ensuring compliance with organizational policies and regulations while providing exceptional service to clients.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks
Determines whether to return, deny, or pay claims following organizational policies and procedures
Accurately enters claims information into the company's database and maintain up-to-date records
Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status
Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements
Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed
Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously
Qualification
Required
Medical Claims experience and/or knowledge of medical claims processes
Knowledge of CPT, ICD-10, and HCPCS coding
Medical terminology
Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change
Aptitude for quickly learning and navigating new technology systems and applications
Ability to think analytically
Strong focus on accuracy and detail
Proficiency in all Microsoft Office Programs, including Word, PowerPoint, and Excel
Preferred
Billing experience
Coding Certification
Previous inbound call center or related customer service experience
Knowledge of HIPAA 837 and 835 electronic claims transactions
Knowledge of Medicare Risk Adjustment and/or Medicaid processes
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
Founded in 1964
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-16
2026-01-14
2026-01-13
Company data provided by crunchbase