Remote Claims Research & Resolution Specialist

Humana Inc; Phoenix (AZ); A distancia; USD 43.000 - 56.000; Jornada completa

Descripción de la vacante

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, validation, and settlement.

You will work with providers, members, and third-party services, reporting to the Supervisor, Claims & Research Resolution. This remote role requires healthcare customer service and call center experience, proficiency in Excel and Word, and knowledge of Medicare/Medicaid claims.

Formación

• 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.

Responsabilidades

• 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 claims, call center, and provider teams to research pending claims issues.
• Apply judgment in determining methods and workflows for managing administrative tasks and projects.
• Demonstrate autonomy in resolving claims inquiries.
• Handle support requests from multiple channels based on inventory load.

Conocimientos

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Remote work

Herramientas

Microsoft Access

Descripción del empleo

Humana Inc. is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, validation, and settlement.

You will work with providers, members, and third-party services, reporting to the Supervisor, Claims & Research Resolution. This remote role requires healthcare customer service and call center experience, proficiency in Excel and Word, and knowledge of Medicare/Medicaid claims.