Remote Claims Research & Resolution Specialist

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

Descripción de la vacante

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations and settlements. You will work with providers, members, and third-party services to achieve timely, accurate resolutions and ensure compliance with internal policies.

The role emphasizes healthcare terminology proficiency, Medicare/Medicaid claims knowledge, and strong customer service experience, with a remote schedule and potential travel for training?

Formación

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

Responsabilidades

• 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 a 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 between projects and handle support requests from multiple channels based on inventory load.

Conocimientos

Healthcare customer service experience

Call center experience

Medicare/Medicaid claims knowledge

Healthcare terminology knowledge

Herramientas

Excel

Word

Descripción del empleo

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claim investigations and settlements. You will work with providers, members, and third-party services to achieve timely, accurate resolutions and ensure compliance with internal policies.

The role emphasizes healthcare terminology proficiency, Medicare/Medicaid claims knowledge, and strong customer service experience, with a remote schedule and potential travel for training?