Remote Claims Research & Resolution Specialist

Humana Inc; Frankfort (KY); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. in Kentucky 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. Responsibilities include working with providers, members, and third-party services to resolve complex medical claims; investigating discrepancies; ensuring compliance; collaborating with specialized teams; applying judgment on workflows; and handling multiple

Qualifications

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

Responsibilities

• Work with providers, members, and third-party collection services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure compliance with policies.
• Collaborate with claims, call center, and provider teams to resolve pending issues.
• Apply advanced judgment to determine methods and workflows for administrative tasks.
• Demonstrate autonomy using experience to resolve claims inquiries.
• Pivot between projects and handle diverse support requests based on workload.

Skills

Healthcare CS

Call Center

Excel

Word

Healthcare Terminology

Medicare/Medicaid

Tools

Microsoft Access

Job description

Humana Inc. in Kentucky 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. Responsibilities include working with providers, members, and third-party services to resolve complex medical claims; investigating discrepancies; ensuring compliance; collaborating with specialized teams; applying judgment on workflows; and handling multiple