Remote Claims Research & Resolution Specialist

Humana Inc; Denver (CO); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement activities for and against the organization.

You will report to the Supervisor, Claims & Research Resolution. You will work with providers, members, and third-party services to resolve complex medical claims, verify documentation, and ensure compliance with policies and regulatory standards.

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 research pending claims issues.
• Apply judgment and discretion to determine appropriate methods, strategies, and workflows for managing administrative tasks.
• Demonstrate autonomy and use experience to resolve claims inquiries.
• Handle support requests from multiple channels based on inventory load.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Job description

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement activities for and against the organization.

You will report to the Supervisor, Claims & Research Resolution. You will work with providers, members, and third-party services to resolve complex medical claims, verify documentation, and ensure compliance with policies and regulatory standards.