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The Subrogation Representative 3 is responsible for identifying, investigating, and recovering funds from third parties who are legally liable for medical expenses. This role collaborates with attorneys and insurance professionals to assess liability and ensures accurate maintenance of Coordination of Benefits (COB) records. The associate supports compliance with subrogation policies and procedures while delivering high-quality service and maintaining confidentiality of member information. This position reports to a Supervisor within the Subrogation Department.

• Review and process subrogation correspondence and referrals within CRM systems (CAS/MTV) to determine appropriate handling under Third-Party Liability guidelines
• Validate and match member information in CAS/MTV to ensure accurate case identification and documentation
• Create and manage cases/events in Troveris to support recovery efforts from attorneys, insurance carriers, and other responsible parties
• Generate and send outbound correspondence using the EMME system in accordance with established workflows and timelines
• Handle outbound calls using the Genesys system to communicate with third parties, obtain additional information related to correspondence received, and determine appropriate handling for cases involving non-pursuable member groups
• Assess liability details and supporting documentation to identify subrogation opportunities and support recovery strategies
• Ensure accurate documentation and timely updates across CRM, Troveris, and EMME systems for all case activities
• Route cases appropriately to Subrogation, Other Party Liability, Coordination of Benefits, or other departments based on established guidelines
• Manage a high-volume, production-driven workload while meeting quality, accuracy, and compliance standards, including HIPAA and data privacy requirements

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Parental and caregiver leave

Employee charity matching program

Network Resource Groups (NRGs)

Career development opportunities

Use your skills to make an impact
 

Required Qualifications

• 1+ year of experience in healthcare and/or subrogation experience in the property, casualty, or worker's compensation fields
• 2+ years of experience in a call center and/or production environment
• Experience assessing severity of support requests and escalate based on severity
• MS Proficiency - Ability to create forms, reports, and documents in Word and Excel
• Typing and computer navigation skills, including use of multiple computer applications simultaneously
• Strong organizational abilities

Preferred Qualifications

• Undergraduate Degree
• Bilingual in English/Spanish
• Claims Processing Experience

Additional Information

Work-At-Home Requirements

• To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 associates 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

Our Hiring Process

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

#LI-LM1

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.

 

$34,400 - $45,000 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.

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.

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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.