Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations, negotiations, and settlements. You will collaborate with providers, members, and third-party teams to resolve issues, adhering to internal policies and regulatory standards.

Training lasts 8 weeks with a Monday–Friday schedule; after training, shifts run Monday–Friday 6:00am–5:30pm EST. A commitment of 18 months is expected, with occasional travel for training or meetings.

Qualifications

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

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy compliance.
• Collaborate with claims, call center, and provider teams to resolve pending issues.
• Apply judgment to determine effective methods, strategies, and workflows.
• Demonstrate autonomy using experience and organizational knowledge to resolve inquiries.
• Handle multiple projects and channels based on inventory load.

Skills

Healthcare customer service

Call center experience

Healthcare terminology knowledge

Medicare/Medicaid claims knowledge

Tools

Excel

Word

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations, negotiations, and settlements. You will collaborate with providers, members, and third-party teams to resolve issues, adhering to internal policies and regulatory standards.

Training lasts 8 weeks with a Monday–Friday schedule; after training, shifts run Monday–Friday 6:00am–5:30pm EST. A commitment of 18 months is expected, with occasional travel for training or meetings.