Remote Claims Research & Resolution Specialist

Humana; New York (NY); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to join our team. This role focuses on resolving complex medical claims with providers, members, and third parties, applying in-depth knowledge to verify documentation and ensure regulatory compliance.

You will report to the Supervisor, Claims & Research Resolution. The position is remote with training and occasional travel for meetings, offering a stable 40-hour schedule and a commitment period after onboarding.

Qualifications

• Healthcare customer service experience required.
• Call center experience required.
• Proficiency with Excel and Word.
• Working knowledge of healthcare terminology.
• Familiarity with Medicare or Medicaid claims.

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure compliance with internal policies.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply judgment to determine methods and workflows for administrative tasks and projects.
• Maintain autonomy and effectively resolve claims inquiries.
• Handle multiple projects across channels based on inventory load.

Skills

Healthcare customer service

Call center experience

Excel

Microsoft Word

Healthcare terminology

Medicare/Medicaid claims

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to join our team. This role focuses on resolving complex medical claims with providers, members, and third parties, applying in-depth knowledge to verify documentation and ensure regulatory compliance.

You will report to the Supervisor, Claims & Research Resolution. The position is remote with training and occasional travel for meetings, offering a stable 40-hour schedule and a commitment period after onboarding.