Manager, Claims Research & Resolution

Become a part of our caring community and help us put health first
 Are you ready to lead and make a real impact? Join us as our Manager, Claims Research & Resolution—a key leadership role where you’ll drive critical claims operations, oversee complex investigations, and ensure fair settlements for and against our organization. In this dynamic position, you’ll leverage your advanced technical expertise to solve challenging problems, guide a dedicated team, and shape the future of our claims process. You’ll have the autonomy to set objectives, manage resources, and achieve organizational goals, all while working within established guidelines to deliver outstanding results. Step into a role where your leadership and vision truly matter—apply today and help us set the standard for excellence in claims management.

Key Responsibilities:

• Oversee the end-to-end claims research and resolution process, ensuring accuracy, efficiency, and compliance with organizational policies and regulatory guidelines.
• Lead, coach, and develop a dedicated team of claims professionals, fostering a collaborative and high-performance environment.
• Manage and resolve complex and escalated claims cases, leveraging your technical knowledge and sound judgment.
• Ensure fair settlements for and against the organization, making decisions that balance organizational goals with customer satisfaction.
• Set clear objectives, manage resources, and monitor progress toward departmental and organizational goals.
• Collaborate with cross-functional teams and stakeholders to enhance claims processes and implement best practices.
• Analyze claims data and metrics to identify trends, drive process improvements, and optimize operational performance.
• Maintain up-to-date knowledge of industry regulations, trends, and technologies to ensure continuous improvement and compliance.
• Responsible for maintaining the appropriate staff levels within your area, while maintaining the budget for the calendar year.

*** There are 2 open positions- one will support the Claims Research Unit (CRU) and the other supports the Macess Corrected Claims team.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree, or in lieu of, 5 or more years of management experience
• 3-5 years of claims experience
• 3 or more years of inventory management experience
• Effective presentation and written/oral communication skills
• Proficiency in Microsoft Office applications
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Claims rework experience
• CAS experience

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: 10%- attend strategy sessions
• Typical Workdays/Hours: Monday – Friday, 8:00 am – 5:00 pm EST, with some flexibility as needed

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 [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

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

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.

 

$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.

Application Deadline: 08-13-2025
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.

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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.