Remote Claims Research & Resolution Specialist

Humana Inc; Carson City (NV); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

401(k) retirement savings

Paid time off

Job summary

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, verification, and settlements, coordinating with providers, members and third-party services.

The role requires 1+ year healthcare customer service and call center experience, with intermediate Excel/Word skills and Medicare/Medicaid claims knowledge. Training lasts 8 weeks (Mon-Fri, 8:00am–4:30pm EST); after training, shifts run Mon–Fri 6:00am–5:30pm EST, with an 18-month

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
• Investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards
• Collaborate with claims, call center, and provider teams to resolve pending claims issues
• Apply advanced judgment to determine methods and workflows for managing tasks and projects
• Demonstrate autonomy, using experience to resolve claims inquiries
• Handle support requests from multiple channels based on inventory load

Skills

Healthcare customer service

Call center experience

Excel skills

Word proficiency

Healthcare terminology

Medicare/Medicaid claims knowledge

Tools

Microsoft Access

Job description

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, verification, and settlements, coordinating with providers, members and third-party services.

The role requires 1+ year healthcare customer service and call center experience, with intermediate Excel/Word skills and Medicare/Medicaid claims knowledge. Training lasts 8 weeks (Mon-Fri, 8:00am–4:30pm EST); after training, shifts run Mon–Fri 6:00am–5:30pm EST, with an 18-month