Remote Claims Research & Resolution Specialist

Humana Inc; Boise (ID); 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 Inc. is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement.

You will report to the Supervisor, Claims & Research Resolution, and collaborate across teams to resolve complex medical claims. The role requires healthcare customer service and call center experience, with training for 8 weeks and a 18-month commitment after onboarding.

Qualifications

• 1+ years of Healthcare customer service experience.
• 1+ years of call center experience.
• 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 and verify documentation to ensure policy compliance.
• Collaborate with claims teams to research pending issues across channels.
• Apply judgment to determine appropriate methods and workflows for administrative tasks and projects.
• Demonstrate autonomy and resolve claims inquiries efficiently.

Skills

Healthcare customer service

Call center experience

HIPAA knowledge

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Job description

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

You will report to the Supervisor, Claims & Research Resolution, and collaborate across teams to resolve complex medical claims. The role requires healthcare customer service and call center experience, with training for 8 weeks and a 18-month commitment after onboarding.