Remote Claims Research & Resolution Specialist

Humana; Georgia; À distance; USD 43 000 - 56 000; Plein temps

Avantages offerts par ce poste

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Résumé du poste

Humana's Claims Research & Resolution Representative 3 role focuses on managing claims operations, including customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

Training consists of virtual sessions for 8 weeks, Monday–Friday, 8:00am–4:30pm EST. After training, you will work Monday–Friday, 6:00am–5:30pm EST, with an 18-month commitment to the team.

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.

Responsabilités

• 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 advanced judgment to determine methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate autonomy, using experience and knowledge to resolve claims inquiries.
• Pivot between projects based on business needs and handle support requests from various channels.

Connaissances

Healthcare customer service

Call center experience

Medicare/Medicaid claims knowledge

Healthcare terminology

Outils

Excel

Word

Microsoft Access

Description du poste

Humana's Claims Research & Resolution Representative 3 role focuses on managing claims operations, including customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

Training consists of virtual sessions for 8 weeks, Monday–Friday, 8:00am–4:30pm EST. After training, you will work Monday–Friday, 6:00am–5:30pm EST, with an 18-month commitment to the team.