Remote Claims Research & Resolution Specialist

Humana Inc; Northern (KY); Remote; USD 43,000 - 56,000; Full time

Job summary

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement.

You will work with providers, members, and third-party services to ensure timely, accurate resolution of complex medical claims, applying advanced judgment and discretion across multiple workflows. This remote, United States-based role requires healthcare customer service and call center experience, strong Excel/Word skills, and knowledge

Qualifications

• 1+ years in healthcare customer service
• 1+ years in a call center environment
• Proficient with Excel and Word
• Working knowledge of healthcare terminology
• Familiarity with Medicare/Medicaid claims processes

Responsibilities

• Investigate discrepancies, verify documentation, and resolve claims in compliance with internal policies.
• Collaborate with claims, call center, and provider teams to research complex claims.
• Apply advanced judgment to determine effective methods and workflows for administrative tasks and projects.
• Maintain autonomy while resolving inquiries across multiple channels based on inventory load.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement.

You will work with providers, members, and third-party services to ensure timely, accurate resolution of complex medical claims, applying advanced judgment and discretion across multiple workflows. This remote, United States-based role requires healthcare customer service and call center experience, strong Excel/Word skills, and knowledge