Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations including customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

The role requires healthcare customer service and call center experience, plus Medicare/Medicaid claims knowledge, with remote work and occasional travel for training. Training lasts 8 weeks, then typical shifts Monday–Friday EST.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel and 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 a specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining methods, strategies, and workflows for administrative tasks and projects.
• Demonstrate a high level of autonomy, resolving claims inquiries with experience and organizational knowledge.
• Handle multiple projects and support requests from various channels based on inventory load.

Skills

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Microsoft Access

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations including customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

The role requires healthcare customer service and call center experience, plus Medicare/Medicaid claims knowledge, with remote work and occasional travel for training. Training lasts 8 weeks, then typical shifts Monday–Friday EST.