Remote Claims Research & Resolution Specialist

Humana Inc; Richmond (VA); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Remote work option

Competitive benefits

Job summary

Humana Inc. is seeking a Claims Research & Resolution Representative 3 for remote work. You will interact with providers, members, and third-party services to resolve complex medical claims and ensure compliance across processes.

The role starts with an 8-week virtual training schedule Monday–Friday, 8:00am–4:30pm EST, with no time off during training and first 120 days. After training, shifts run Monday–Friday between 6:00am–5:30pm EST.

Qualifications

• 1+ year of healthcare customer service experience.
• 1+ year 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 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 experience handling support requests from a variety of different channels, based on inventory load

Skills

Healthcare customer service experience

Call center experience

Excel skills

Word proficiency

Healthcare terminology

Medicare/Medicaid claims knowledge

Tools

Microsoft Access

Job description

Humana Inc. is seeking a Claims Research & Resolution Representative 3 for remote work. You will interact with providers, members, and third-party services to resolve complex medical claims and ensure compliance across processes.

The role starts with an 8-week virtual training schedule Monday–Friday, 8:00am–4:30pm EST, with no time off during training and first 120 days. After training, shifts run Monday–Friday between 6:00am–5:30pm EST.