Humana is looking for a Manager, Claims Research & Resolution to lead and manage the end-to-end claims process. You will ensure operational accuracy, efficiency, and compliance while developing a dedicated team and resolving complex cases.

What You'll Do

Oversee the end-to-end claims research and resolution process, ensuring accuracy, efficiency, and compliance.
Lead, coach, and develop a dedicated team of claims professionals, fostering a collaborative environment.
Manage and resolve complex and escalated claims cases with sound judgment.
Ensure fair settlements for and against the organization, balancing goals with customer satisfaction.
Set clear objectives, manage resources, and monitor progress toward departmental goals.
Collaborate with cross-functional teams to enhance claims processes and implement best practices.
Analyze claims data and metrics to identify trends and drive process improvements.
Maintain up-to-date knowledge of industry regulations, trends, and technologies.
Maintain appropriate staff levels while managing the budget for the calendar year.

What We're Looking For

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.
Passion for contributing to an organization focused on continuously improving consumer experiences.

Nice to Have

Claims rework experience.
CAS experience.

Technical Stack

Microsoft Office applications.

Team & Environment

Two open positions: one supporting the Claims Research Unit (CRU) and the other supporting the Macess Corrected Claims team.

Benefits & Compensation

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.
Compensation: $94,900 - $130,500 per year.

Work Mode

This is a hybrid position.

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.