Remote Claims Research & Resolution Specialist

Humana Inc; Northern (KY); Remote; USD 34,000 - 45,000; Full time

Benefits offered by this job

Medical benefits

401(k) retirement plan

Paid time off

Job summary

Humana Inc in Puerto Rico is seeking a Claims Research & Resolution Representative 3 to join our claims operations. You will investigate discrepancies, verify documentation, and resolve complex medical claims with providers, members, and third-party services.

The role requires 1+ years in claims or customer service, English proficiency, and willingness to participate in virtual training and ongoing schedule commitments while supporting a remote work model.

Qualifications

• 1+ years of claims OR customer service experience.
• Knowledge of healthcare terminology is a plus.

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy/regulatory compliance.
• Collaborate with claims, call center, and provider teams to research pending issues.
• Apply judgment to determine processes and workflows for managing tasks and projects.
• Operate with a high level of autonomy to resolve inquiries.

Skills

Claims knowledge

English communication

Customer service

Job description

Humana Inc in Puerto Rico is seeking a Claims Research & Resolution Representative 3 to join our claims operations. You will investigate discrepancies, verify documentation, and resolve complex medical claims with providers, members, and third-party services.

The role requires 1+ years in claims or customer service, English proficiency, and willingness to participate in virtual training and ongoing schedule commitments while supporting a remote work model.