Remote Claims Research & Resolution Specialist

Humana Inc; Atlanta (GA); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement, reporting to the Supervisor, Claims & Research Resolution.

You will work with providers, members, and third-party collection services to resolve complex medical claims and ensure accuracy and compliance with policies and regulatory standards. Training is provided with virtual sessions, followed by ongoing work across shifts and platforms.

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.
• Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, based on business needs, with the ability to experience handling support requests from a variety of different channels, based on inventory load

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Microsoft Access

Tools

Microsoft Access

Job description

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement, reporting to the Supervisor, Claims & Research Resolution.

You will work with providers, members, and third-party collection services to resolve complex medical claims and ensure accuracy and compliance with policies and regulatory standards. Training is provided with virtual sessions, followed by ongoing work across shifts and platforms.