Job Details

Supervisor, Claims Review

Become a part of our caring community and help us put health first. The Supervisor, Claims Review makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Supervisor, Claims Review works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable factors to solve basic problems; collaborates with management and top professionals/specialists in selection of methods, techniques, and analytical approach. The Supervisor, Claims Review partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically related to schedule, plans and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies.

Use your skills to make an impact

Education & Experience:

• Bachelor's degree in business, healthcare administration, or related field, or equivalent experience required.
• Minimum of 3 years' experience in claims review, healthcare operations, or insurance industry, with at least 1 year in a supervisory or team lead role.

Knowledge & Skills:

• Solid understanding of claims processing, insurance guidelines, and provider data interpretation.
• Familiarity with relevant federal and state regulations, including HIPAA and other applicable compliance standards.
• Proficiency in analyzing complex information and applying established guidance to make sound decisions.
• Strong interpersonal, communication, and organizational skills.
• Ability to work collaboratively with professional staff and cross-functional teams.
• Strong inventory management skills.

Leadership & Management:

• Demonstrated ability to supervise, motivate, and provide day-to-day oversight to support and technical associates.
• Skilled in coordinating schedules, managing workloads, and ensuring consistency in team execution.
• Proven track record of holding team members accountable to established policies and procedures.
• Experience handling escalated or complex issues in claims review or related functions.

Technical Competencies:

• Experience with claims management systems, electronic health records, or similar platforms.
• Proficiency in Microsoft Office Suite or comparable software.

Other Requirements:

• Commitment to upholding company policies and compliance standards, including information protection and privacy procedures in alignment with enterprise guidelines.
• Ability to maintain confidentiality and ensure secure handling of sensitive information.
• Strong problem-solving skills and attention to detail.
• Excellent time management and prioritization abilities.

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 $65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

About Us: Humana Inc. 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.

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.