Remote Claims Research & Resolution Specialist

Humana Inc; Augusta (ME); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical insurance

Dental and vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to join the remote, work-from-home team.

The role involves investigating complex medical claims, coordinating with providers, members, and third-party services, and applying judgment to resolve issues in line with policies and regulatory standards. During training, you will undergo virtual instruction for 8 weeks with a Monday–Friday schedule, 8:00am–4:30pm EST, then work a Monday–Friday shift between 6:00am–5:30pm EST.

Qualifications

• 1 or more years of Healthcare customer service experience.
• 1 or more 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 CS

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 join the remote, work-from-home team.

The role involves investigating complex medical claims, coordinating with providers, members, and third-party services, and applying judgment to resolve issues in line with policies and regulatory standards. During training, you will undergo virtual instruction for 8 weeks with a Monday–Friday schedule, 8:00am–4:30pm EST, then work a Monday–Friday shift between 6:00am–5:30pm EST.