Claims Research & Resolution Specialist (Remote)

Humana; Montana; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations, eligibility checks, and settlements. You will collaborate with providers, members, and a support team while maintaining compliance with policies.

The role requires 1+ year in healthcare customer service and call centers, with intermediate Excel/Word and Medicare/Medicaid claims knowledge. Training is 8 weeks, Mon–Fri EST, followed by a 40-hour weekly schedule.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency Word.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare or Medicaid claims.

Responsibilities

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending claims issues.
• Apply advanced judgment to determine methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate autonomy, using experience to resolve claims inquiries.
• Handle multiple projects across channels based on inventory load.

Skills

Healthcare customer service

Call center

Healthcare terminology

Medicare/Medicaid claims

Tools

Excel

Word

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations, eligibility checks, and settlements. You will collaborate with providers, members, and a support team while maintaining compliance with policies.

The role requires 1+ year in healthcare customer service and call centers, with intermediate Excel/Word and Medicare/Medicaid claims knowledge. Training is 8 weeks, Mon–Fri EST, followed by a 40-hour weekly schedule.