Remote Claims Research & Resolution Specialist

Humana; Pennsylvania; Remoto; USD 43.000 - 56.000; Tempo pieno

Descrizione del lavoro

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.

You will work remotely with occasional travel to Humana offices for training or meetings, in a structured 8-week training period and a subsequent 18-month commitment window. The role includes a 40-hour weekly schedule and comprehensive benefits.

Competenze

• 1+ years of Healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel and Word proficiency.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare or Medicaid claims.

Mansioni

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Use in-depth knowledge of claims processes to 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, applying experience and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, based on business needs, with the ability to handle support requests from various channels.

Conoscenze

Healthcare customer service

Call center experience

Excel

Microsoft Word

Healthcare terminology

Medicare/Medicaid claims

Strumenti

Microsoft Access

Descrizione del lavoro

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.

You will work remotely with occasional travel to Humana offices for training or meetings, in a structured 8-week training period and a subsequent 18-month commitment window. The role includes a 40-hour weekly schedule and comprehensive benefits.