Remote Claims Research & Resolution Specialist

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

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations, involving customer contact, investigation, and settlement. The role reports to the Supervisor, Claims & Research Resolution. Training is 8 weeks Mon-Fri 8:00am-4:30pm EST, then shifts 6:00am-5:30pm EST, Monday–Friday.

Remote position with potential travel to Humana offices for training/meetings. 40 hours weekly; pay range $43,000–$56,200/year.

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 methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate autonomy, using experience and knowledge to resolve claims inquiries.
• Handle support requests from multiple channels based on inventory load and business needs.

Skills

Healthcare CS

Call center

Excel

Word

Healthcare terms

Medicare Medicaid

Microsoft Access

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations, involving customer contact, investigation, and settlement. The role reports to the Supervisor, Claims & Research Resolution. Training is 8 weeks Mon-Fri 8:00am-4:30pm EST, then shifts 6:00am-5:30pm EST, Monday–Friday.

Remote position with potential travel to Humana offices for training/meetings. 40 hours weekly; pay range $43,000–$56,200/year.