Claims Processing Professional

Become a part of our caring community   As a Claims Processing Professional, you'll review healthcare claims to help ensure their accuracy. You'll review claim information, verify eligibility, authorizations, and provider contracts, and determine appropriate claim outcomes while following established policies and regulatory guidelines. In this in-office position reporting to the Enterprise Transformation Director, you'll collaborate with other teams, navigate multiple systems, and help deliver claim resolutions that support a positive experience for providers and members. If you enjoy making an impact behind the scenes, we'd love to have you on our team. As a Claims Processing Professional, you will: Review and process healthcare claims within established turnaround times. Verify member eligibility, provider information, authorizations, and contractual requirements before processing claims. Determine whether you should approve, deny, adjust, or return claims for additional information. Resolve claim discrepancies by gathering and evaluating supporting documentation. Process both electronic and paper claims while maintaining productivity, quality, and accuracy standards. Use multiple internal systems to review claims, document findings, and complete claim processing. Maintain compliance with HIPAA regulations, organizational policies, and all applicable state and federal guidelines. Collaborate with internal departments to resolve claim issues and support claim adjudication. Adapt to evolving business processes, system enhancements and regulatory changes. Meet productivity, quality, and performance expectations. Use your skills to make an impact   Required Qualifications Minimum of 1 year of healthcare claims processing experience . Knowledge of healthcare claims processing practices and medical insurance terminology. Work across multiple computer systems. Prioritize multiple tasks and work independently. Commitment to HIPAA compliance.

Experience processing medical, home health, or managed care claims. Knowledge of CPT, ICD-10, and HCPCS coding. Experience working with provider contracts, authorizations, or eligibility verification. Bilingual (English/Spanish). Associate's degree or higher in Business, Healthcare Administration, or a related field.     Scheduled Weekly Hours 40 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.   $53,700 - $72,600 per year   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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to