Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Parental and caregiver leave

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 in a remote capacity to manage complex medical claims with investigators and providers. You will resolve inquiries, verify documentation, and ensure policy compliance while coordinating with a team of claims and call center staff.

Required are 1+ year in healthcare customer service and call center experience, plus intermediate Excel and Word skills, and knowledge of Medicare/Medicaid claims.

Qualifications

• 1+ year of healthcare customer service experience.
• 1+ year of call center experience.
• Intermediate Excel and Word skills.
• 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.
• Use in-depth knowledge of claims processes to 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 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 from one project to the next, based on business needs, with the ability to experience handling support requests from a variety of different channels, based on inventory load

Skills

Healthcare CS

Call center

Intermediate Excel

Word proficiency

Healthcare terminology

Medicare claims

Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 in a remote capacity to manage complex medical claims with investigators and providers. You will resolve inquiries, verify documentation, and ensure policy compliance while coordinating with a team of claims and call center staff.

Required are 1+ year in healthcare customer service and call center experience, plus intermediate Excel and Word skills, and knowledge of Medicare/Medicaid claims.