Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. The role reports to the Supervisor, Claims & Research Resolution.

Join Humana’s remote team to collaborate with providers, members, and third-party services, exercising judgment to resolve complex claims efficiently while adhering to policy and regulatory standards.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency in 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 policy compliance.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply judgment to determine appropriate methods and workflows for tasks and projects.
• Demonstrate autonomy and organizational knowledge to resolve inquiries.
• Handle support requests across multiple channels based on inventory load.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid knowledge

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. The role reports to the Supervisor, Claims & Research Resolution.

Join Humana’s remote team to collaborate with providers, members, and third-party services, exercising judgment to resolve complex claims efficiently while adhering to policy and regulatory standards.