Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Health benefits

401(k) retirement savings

Paid time off

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third parties. The remote role reports to the Supervisor, Claims & Research Resolution and includes training, rotating shifts, and ongoing case investigations.

Initial 8-week virtual training runs Monday–Friday, 8:00am–4:30pm EST; after training you may work Monday–Friday 6:00am–5:30pm EST with an 18-month commitment.

Qualifications

• 1 or more years of Healthcare customer service experience.
• 1 or more 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 resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure compliance with policies.
• Collaborate with claims, call center, and provider teams on pending issues.
• Apply judgment to determine methods and workflows for administrative tasks.
• Handle multiple projects and support requests from various channels.
• Maintain on-time performance during training and post-training shifts.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third parties. The remote role reports to the Supervisor, Claims & Research Resolution and includes training, rotating shifts, and ongoing case investigations.

Initial 8-week virtual training runs Monday–Friday, 8:00am–4:30pm EST; after training you may work Monday–Friday 6:00am–5:30pm EST with an 18-month commitment.