Remote Claims Research & Resolution Specialist

Humana Inc; Lansing (MI); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third-party services. You will investigate discrepancies, verify documentation, and ensure policy compliance.

During training you will have virtual sessions for 8 weeks, with a Monday–Friday schedule (8:00am–4:30pm EST). After training, you may work any shift 6:00am–5:30pm EST, with a remote work setup and occasional travel to Humana offices for training or meetings.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency 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.
• 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, handling support requests from various channels based on inventory load.

Skills

Healthcare CS

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana Inc is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third-party services. You will investigate discrepancies, verify documentation, and ensure policy compliance.

During training you will have virtual sessions for 8 weeks, with a Monday–Friday schedule (8:00am–4:30pm EST). After training, you may work any shift 6:00am–5:30pm EST, with a remote work setup and occasional travel to Humana offices for training or meetings.