Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex claims, coordinating with providers, members and third-party services. You will investigate, verify documentation, and ensure regulatory compliance while collaborating with cross-functional teams.

The role offers remote work with full-time hours, 40 weekly, and required training sessions. After training, shifts run Mon–Fri, EST, with a commitment of 18 months in this team.

Qualifications

• 1+ year of healthcare customer service experience.
• 1+ year of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency with 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 and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending claims issues.
• Apply judgment to determine methods, strategies, and workflows for administrative tasks and projects.
• Demonstrate autonomy and organizational knowledge to resolve claims inquiries.
• Handle multiple projects and support requests from various channels as needed.

Skills

Healthcare customer service

Call center experience

Excel skills

Word

Healthcare terminology

Medicare/Medicaid claims

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex claims, coordinating with providers, members and third-party services. You will investigate, verify documentation, and ensure regulatory compliance while collaborating with cross-functional teams.

The role offers remote work with full-time hours, 40 weekly, and required training sessions. After training, shifts run Mon–Fri, EST, with a commitment of 18 months in this team.