Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid time off

Parental leave

Disability insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 for a remote role. You will manage complex medical claim investigations, work with providers and members, and report to the Supervisor, Claims & Research Resolution.

The position requires 1+ year of healthcare CS and call center experience, Medicare/Medicaid claims knowledge, and intermediate Excel/Word skills. Training lasts 8 weeks with Monday–Friday schedules, then shifts Monday–Friday 6:00am–5:30pm EST.

Qualifications

• 1+ years of Healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate Word skills.
• 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, verify documentation, and ensure policy/regulatory compliance.
• Collaborate with claims, call center, and provider teams to research issues.
• Apply judgment to determine methods and workflows for administrative tasks and projects.
• Demonstrate autonomy in resolving claims inquiries across channels.
• Handle multiple projects and adapt to changing business needs.

Skills

Healthcare CS experience

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 for a remote role. You will manage complex medical claim investigations, work with providers and members, and report to the Supervisor, Claims & Research Resolution.

The position requires 1+ year of healthcare CS and call center experience, Medicare/Medicaid claims knowledge, and intermediate Excel/Word skills. Training lasts 8 weeks with Monday–Friday schedules, then shifts Monday–Friday 6:00am–5:30pm EST.