HumanaHU

Risk Adjustment Representative 3

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky, offering a wide range of insurance products and health and wellness services.

Humana

Employee count: 5000+

Salary: 25k-56k USD

United States only

Become a part of our caring community and help us put health first

The Risk Adjustment Representative 3 is responsible for contacting provider offices to obtain medical records and/or set up onsite visits for Record Retrieval Specialists to retrieve medical records. The Risk Adjustment Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

The Risk Adjustment Representative 3 (Scheduler) ensures sites with open medical records requests are contacted in order for Humana to obtain a copy of records. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. Candidate may be asked to travel locally for record retrieval assistance at provider offices or hospitals if there is a business need.

  • Min # of phone calls per day to assigned list of providers

  • Management of sites assigned and tracking of records received to a specified goal

  • Document progress/calls made daily/complete daily productivity report

  • Research site information/update information internally


Use your skills to make an impact

Required Qualifications

  • High School Diploma

  • 1 or more years of Customer Service experience

  • Proficiency in Microsoft Office applications: Word and Excel

  • Must have reliable transportation

  • This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

  • Strong written and verbal communication skills

  • Organizational and time management skills

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Knowledge of ICD-9/10 coding

  • Medical record terminology

  • Knowledge and experience in health care environment/managed care (provider office, billing, coding, medical records, etc.)

Additional Information

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.

Work At Home / Internet Guidance:

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.

If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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.$43,000 - $56,200 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 04-28-2025


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.

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.

About the job

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Posted on

Job type

Full Time

Experience level

Mid-level

Salary

Salary: 25k-56k USD

Location requirements

Hiring timezones

United States +/- 0 hours

About Humana

Learn more about Humana and their company culture.

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Humana Inc. is dedicated to improving the health and well-being of the millions of people it serves. Our customers often navigate complex healthcare systems and face challenges in accessing affordable, high-quality care. That's why we are committed to putting health first, not just for our members, but also for our teammates and the broader communities we impact. We understand that true health encompasses more than just physical well-being; it includes emotional, social, and financial health. Therefore, we strive to offer personalized care from people who genuinely care, listening to our members' needs and creating solutions that help them achieve their best selves. Our approach is rooted in an integrated care delivery model that aims to simplify the healthcare experience, making it easier for individuals and families to get the right care at the right time.

Since our founding in 1961, initially as a nursing home company and later evolving into a leading health insurance provider, Humana has consistently adapted to meet the changing needs of the healthcare landscape. We specialize in government-sponsored programs, with a significant portion of our medical membership stemming from Medicare Advantage, Medicaid, and TRICARE. Beyond traditional insurance, Humana is increasingly focused on providing comprehensive healthcare services, including primary care, at-home care, and pharmacy benefit management through our CenterWell brand. We recognize that many of our customers, particularly seniors, are managing multiple chronic conditions. Our integrated care delivery model, which leverages both high-tech tools like data analytics and personalized, low-tech interactions such as in-home visits, allows us to predict, slow, and sometimes even prevent disease progression. We are deeply invested in the communities we serve, working to address health disparities and improve local health outcomes through initiatives like our Bold Goal, which aims to improve the health of the communities we serve by making it easier for people to achieve their best health.

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Humana hiring Risk Adjustment Representative 3 • Remote (Work from Home) | Himalayas