Remote Claims Research & Resolution Specialist

Humana Inc; Lincoln (NE); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. is hiring for a Claims Research & Resolution Representative 3. This remote role involves interacting with providers, members, and third-party services to resolve complex claims. You’ll train for 8 weeks with Mon–Fri 8:00am–4:30pm EST and must remain in the role for 18 months after training.

After training, you’ll work any shift Mon–Fri, 6:00am–5:30pm EST, and occasionally travel to Humana offices for training or meetings. The position pays $43,000–$56,200 annually plus benefits.

Qualifications

• 1+ year healthcare customer service experience.
• 1+ year call center experience.
• 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 to determine methods and workflows for managing administrative tasks and projects.
• Demonstrate autonomy, using experience and knowledge to resolve claims inquiries.
• Pivot between projects based on business needs and inventory load.

Skills

Healthcare customer service

Call center experience

Medicare/Medicaid knowledge

Healthcare terminology

Tools

Excel

Word

Job description

Humana Inc. is hiring for a Claims Research & Resolution Representative 3. This remote role involves interacting with providers, members, and third-party services to resolve complex claims. You’ll train for 8 weeks with Mon–Fri 8:00am–4:30pm EST and must remain in the role for 18 months after training.

After training, you’ll work any shift Mon–Fri, 6:00am–5:30pm EST, and occasionally travel to Humana offices for training or meetings. The position pays $43,000–$56,200 annually plus benefits.