Remote Claims Research & Resolution Specialist

Humana; Maine; A distancia; USD 43.000 - 56.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Descripción de la vacante

Humana is seeking a Claims Research & Resolution Representative 3 to join a remote team. You will handle claims operations, contact members and providers, investigate discrepancies, and settle complex medical claims under supervision.

The role begins with 8 weeks of virtual training, Monday–Friday 8:00am–4:30pm EST, with strict attendance. Post-training, shifts are Monday–Friday 6:00am–5:30pm EST. Compensation ranges from $43,000 to $56,200 annually, plus comprehensive benefits.

Formación

• 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.

Responsabilidades

• Work with providers, members, and third-party collection services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending claims issues.
• Apply judgment in determining methods and workflows for administrative tasks and projects.
• Demonstrate autonomy and use organizational knowledge to resolve claims inquiries.
• Handle support requests from multiple channels based on workload.

Conocimientos

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Herramientas

Microsoft Access

Descripción del empleo

Humana is seeking a Claims Research & Resolution Representative 3 to join a remote team. You will handle claims operations, contact members and providers, investigate discrepancies, and settle complex medical claims under supervision.

The role begins with 8 weeks of virtual training, Monday–Friday 8:00am–4:30pm EST, with strict attendance. Post-training, shifts are Monday–Friday 6:00am–5:30pm EST. Compensation ranges from $43,000 to $56,200 annually, plus comprehensive benefits.