Remote Claims Research & Resolution Specialist

Humana; South Dakota; Remote; USD 43,000 - 56,000; Full time

Job summary

Humana is hiring for a Claims Research & Resolution Representative 3. The role is remote with 40-hour weeks and 8-week virtual training, Monday–Friday 8:00am–4:30pm EST during training. After training, shifts may vary within 6:00am–5:30pm EST.

The position requires 18 months in the role and travel may be needed for training. Starting pay ranges from $43,000 to $56,200 per year, with benefits including health/dental/vision, 401(k), and paid time off.

Qualifications

• 1+ years of Healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency in 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 in determining methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate autonomy and organizational knowledge to resolve claims inquiries.

Skills

Healthcare CS

Call Center

Excel

Word

Healthcare Terminology

Medicare/Medicaid Claims

Tools

Microsoft Access

Job description

Humana is hiring for a Claims Research & Resolution Representative 3. The role is remote with 40-hour weeks and 8-week virtual training, Monday–Friday 8:00am–4:30pm EST during training. After training, shifts may vary within 6:00am–5:30pm EST.

The position requires 18 months in the role and travel may be needed for training. Starting pay ranges from $43,000 to $56,200 per year, with benefits including health/dental/vision, 401(k), and paid time off.