Remote Claims Research & Resolution Specialist

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

Job summary

Humana 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 join a remote team supporting members, providers, and partners.

During training you will work 8 weeks Mon–Fri 8:00am–4:30pm EST, then shift to Mon–Fri 6:00am–5:30pm EST; 40 hours/week. Travel occasionally to Humana offices may be required, with a strong emphasis on regulatory

Qualifications

• 1+ years of Healthcare customer service experience.

Responsibilities

• Work with providers, members, and third-party collection services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure regulatory compliance.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply judgment to determine methods and workflows for admin tasks and projects.
• Demonstrate autonomy and use organizational knowledge to resolve inquiries.
• Pivot between projects and handle support requests from multiple channels.

Skills

Healthcare CS

Call center experience

Excel (intermediate)

Word (intermediate)

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana 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 join a remote team supporting members, providers, and partners.

During training you will work 8 weeks Mon–Fri 8:00am–4:30pm EST, then shift to Mon–Fri 6:00am–5:30pm EST; 40 hours/week. Travel occasionally to Humana offices may be required, with a strong emphasis on regulatory