Remote Claims Research & Resolution Specialist

Humana; Connecticut; Remoto; USD 43.000 - 56.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Descrizione del lavoro

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlements. This remote role reports to the Supervisor, Claims & Research Resolution.

Training runs eight weeks, Monday–Friday 8:00am–4:30pm EST; attendance is essential. After training, shifts are Mon–Fri 6:00am–5:30pm EST, with an 18-month commitment and potential travel for training.

Competenze

• 1+ year of healthcare customer service experience.
• 1+ year of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency Word.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare or Medicaid claims.

Mansioni

• Work with providers, members, and third-party collection services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy compliance with internal policies and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply advanced judgment to determine appropriate methods and workflows for managing tasks and projects.
• Demonstrate autonomy in resolving claims inquiries.
• Handle multiple projects and channels per business needs.

Conoscenze

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Strumenti

Microsoft Access

Descrizione del lavoro

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlements. This remote role reports to the Supervisor, Claims & Research Resolution.

Training runs eight weeks, Monday–Friday 8:00am–4:30pm EST; attendance is essential. After training, shifts are Mon–Fri 6:00am–5:30pm EST, with an 18-month commitment and potential travel for training.