Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical, Dental, Vision benefits

401(k) retirement plan

Paid time off

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage investigations and settlements for complex medical claims. This remote role reports to the Supervisor, Claims & Research Resolution and collaborates with providers, members, and third-party services.

During training, 8 weeks Mon–Fri 8:00am–4:30pm EST; after training, shifts Mon–Fri 6:00am–5:30pm EST. Pay range is $43,000–$56,200 annually.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel and Word skills.
• Working knowledge of healthcare terminology and Medicare/Medicaid claims.

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies and verify documentation per policies and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply judgment to determine methods and workflows for administrative tasks.
• Maintain autonomy while resolving inquiries across multiple channels.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage investigations and settlements for complex medical claims. This remote role reports to the Supervisor, Claims & Research Resolution and collaborates with providers, members, and third-party services.

During training, 8 weeks Mon–Fri 8:00am–4:30pm EST; after training, shifts Mon–Fri 6:00am–5:30pm EST. Pay range is $43,000–$56,200 annually.