Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings plan

Paid time off

Paid holidays

Parental leave

Disability insurance

Life insurance

Job summary

Humana 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, and collaborate with providers, members, and third-party services to resolve complex medical claims.

The role requires 1+ year of healthcare customer service and call center experience, with intermediate Excel and Word skills, plus knowledge of Medicare/Medicaid claims.

Qualifications

• 1+ year of healthcare customer service experience.
• 1+ year 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 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 and workflows for managing administrative tasks and projects.
• Demonstrate autonomy to resolve claims inquiries.
• Pivot between projects and handle support requests from multiple channels based on workload.

Skills

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana 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, and collaborate with providers, members, and third-party services to resolve complex medical claims.

The role requires 1+ year of healthcare customer service and call center experience, with intermediate Excel and Word skills, plus knowledge of Medicare/Medicaid claims.