Remote Claims Research & Resolution Specialist

Humana; North Carolina; Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is hiring for a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution and work with providers, members, and third-party services to resolve complex medical claims.

The role requires experience in healthcare customer service and call centers, with intermediate Excel/Word skills and knowledge of Medicare or Medicaid claims.

Qualifications

• 1+ years of Healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency Word.
• 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.
• 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 and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, handling support requests from various channels based on inventory load.

Skills

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is hiring for a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution and work with providers, members, and third-party services to resolve complex medical claims.

The role requires experience in healthcare customer service and call centers, with intermediate Excel/Word skills and knowledge of Medicare or Medicaid claims.