Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to join our remote team, supporting claims with providers, members, and third-party services. You will work on complex medical claims and report to the Supervisor, Claims & Research Resolution.

The role emphasizes autonomy, process improvement, and accuracy across investigations, documentation, and regulatory compliance. Training is provided; after training, shifts are Mon–Fri with EST hours; total weekly hours are 40.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills; intermediate Word.
• 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.
• Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, based on business needs, with the ability to handle support requests from various channels.

Skills

Healthcare customer service

Call center experience

Healthcare terminology

Medicare/Medicaid claims

Tools

Excel

Word

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to join our remote team, supporting claims with providers, members, and third-party services. You will work on complex medical claims and report to the Supervisor, Claims & Research Resolution.

The role emphasizes autonomy, process improvement, and accuracy across investigations, documentation, and regulatory compliance. Training is provided; after training, shifts are Mon–Fri with EST hours; total weekly hours are 40.