Remote Claims Research & Resolution Specialist

Humana; New Mexico; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, verification, and settlement. You will work with providers, members, and third-party services to ensure timely, accurate resolutions.

You will train in 8 weeks, Monday–Friday, 8:00am–4:30pm EST, with after-training shifts 6:00am–5:30pm EST. A commitment of 18 months is required following training.

Qualifications

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

Responsibilities

• Work with providers, members, and third-party 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 claims, call center, and provider teams to research pending issues.
• Apply advanced judgment to determine methods and workflows for managing administrative tasks and projects.
• Demonstrate autonomy and organizational knowledge to resolve claims inquiries.
• Pivot between projects and handle support requests from various channels as workload requires.

Skills

Healthcare customer service experience

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, verification, and settlement. You will work with providers, members, and third-party services to ensure timely, accurate resolutions.

You will train in 8 weeks, Monday–Friday, 8:00am–4:30pm EST, with after-training shifts 6:00am–5:30pm EST. A commitment of 18 months is required following training.