Remote Claims Research & Resolution Specialist

Humana Inc; Little Rock (AR); 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 managing claims operations, interviewing providers and members, and researching complex medical claims with a focus on accuracy and compliance. You will report to the Supervisor, Claims & Research Resolution.

Initial 8-week virtual training with Monday–Friday, 8:00am–4:30pm EST is provided. After training, you’ll work any shift Mon–Fri between 6:00am–5:30pm EST, with an 18-month tenure commitment.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate Word proficiency.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare or Medicaid claims.

Responsibilities

• Collaborate with providers, members, and third-party collection services to resolve complex medical claims.
• Investigate discrepancies and verify documentation to ensure compliance with policies and regulations.
• Coordinate with a team of claims, call center, and provider staff to research pending claims issues.
• Apply judgment to determine methods and workflows for administrative tasks and projects.
• Demonstrate autonomy using experience and knowledge to resolve claims inquiries.
• Handle support requests from various channels based on inventory load.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana Inc. is hiring for a Claims Research & Resolution Representative 3. This remote role involves managing claims operations, interviewing providers and members, and researching complex medical claims with a focus on accuracy and compliance. You will report to the Supervisor, Claims & Research Resolution.

Initial 8-week virtual training with Monday–Friday, 8:00am–4:30pm EST is provided. After training, you’ll work any shift Mon–Fri between 6:00am–5:30pm EST, with an 18-month tenure commitment.