Remote Claims Research & Resolution Specialist

Humana; Ohio; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement of claims. You will report to the Supervisor, Claims Research Resolution.

After eight weeks of virtual training (Mon–Fri, 8:00am–4:30pm EST), you will transition to shifts Mon–Fri between 6:00am–5:30pm EST. A remote role with occasional travel to Humana offices may be required.

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 a team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining approaches for managing tasks and projects.
• Demonstrate autonomy in resolving claims inquiries.
• Handle support requests 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 is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement of claims. You will report to the Supervisor, Claims Research Resolution.

After eight weeks of virtual training (Mon–Fri, 8:00am–4:30pm EST), you will transition to shifts Mon–Fri between 6:00am–5:30pm EST. A remote role with occasional travel to Humana offices may be required.