Remote Claims Research & Resolution Specialist

Humana Inc; Salem (OR); Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings plan

Paid time off

Parental and caregiver leave

Disability insurance

Life insurance

Job summary

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

During training, you will have virtual training for 8 weeks, with a schedule of Monday – Friday, 8:00am – 4:30pm EST. After training, you may work any shift Monday – Friday, between 6:00am – 5:30pm EST, and occasional travel to Humana's 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 specialized team to research pending claims issues.
• Apply advanced judgment and discretion in determining methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy in resolving claims inquiries.
• Pivot quickly between projects based on business needs and handle support requests from various channels.

Skills

Healthcare customer service

Call center experience

Healthcare terminology

Tools

Excel

Word

Medicare/Medicaid claims

Job description

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

During training, you will have virtual training for 8 weeks, with a schedule of Monday – Friday, 8:00am – 4:30pm EST. After training, you may work any shift Monday – Friday, between 6:00am – 5:30pm EST, and occasional travel to Humana's offices may be required.