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Claims Research and Resolution Prof

Humana · IL · Remote available · $59,300–$80,900 a year · Full time

Posted Oct 2, 2026 · We last checked this listing on Oct 6, 2026

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Likely interview questions for this role

Written from this job description, not a generic list. Each one notes what the interviewer is really checking.

About your past

This role approves claim settlements both for and against the company. How do you stay fair when the money goes either way?

What they are checking: Whether they decide on the facts and policy rather than defaulting to whatever saves the company money.

The posting says assignments often require interpretation and independent judgment. Tell me about a time you made a call when the guidelines didn't clearly cover the case.

What they are checking: Whether they can reason from policy intent and know when to ask for guidance.

How do you keep track of many open claims so none sit unresolved for weeks?

What they are checking: Whether they manage a queue with follow-ups and priorities instead of working only what is in front of them.

Tell me about a time you spotted a pattern in errors rather than just fixing one case.

What they are checking: Whether they look for system problems that cause repeat claims issues and raise them.

This role is work at home. How do you stay focused and productive without a team around you?

What they are checking: Whether they can manage their own time and stay accurate in a remote setting.

What would you do

A provider calls frustrated because the same claim has been denied three times. How do you handle the call?

What they are checking: Whether they can calm the caller, own the issue and find the root cause instead of resubmitting blindly.

You find an overpayment that went to a provider months ago. What steps would you take?

What they are checking: Whether they know recovery involves documentation, notice and sometimes collection services, handled professionally.

How do you explain a complex claim decision to a member who doesn't know insurance terms?

What they are checking: Whether they can translate technical decisions into plain language that improves the consumer experience.

About the work

Walk me through how you would research a claim a provider says was underpaid.

What they are checking: Whether they have a methodical approach that checks contracts, coding, eligibility and payment history before deciding.

What's the difference between a claim denial and a claim adjustment, and why does it matter to a member?

What they are checking: Whether they understand basic claims concepts and how decisions affect what a member owes.

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The full job description

As published by Humana.

Become a part of our caring community The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against us. Approve all claim settlements both for and against us. The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Claims Research & Resolution Professional 2 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Regarding own work methods, occasionally in, and and receive guidance where needed. Follow established guidelines/procedures. Use your skills to make an impact Required Qualifications • Less than 5 years of technical experience • Must be passionate about contributing to an organization focused on improving consumer experiences Preferred Qualifications Bachelors Degree Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. 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. $59,300 - $80,900 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

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