Remote Claims Research & Resolution Specialist

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

Descrizione del lavoro

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation and settlement, collaborating with providers, members, and third-party services.

You will use in-depth knowledge of claims processes, internal policies, and regulatory standards to resolve inquiries with autonomy, while supporting a fast-paced call center environment across multiple channels.

Competenze

• 1+ year healthcare customer service experience.
• 1+ year call center experience.
• Intermediate Excel and Word skills.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare/Medicaid claims.

Mansioni

• Resolve complex medical claims with providers, members, and third-party services.
• Investigate discrepancies and verify documentation per policies.
• Collaborate with claims, call center, and provider teams.
• Apply sound judgment to determine methods and workflows for admin tasks and projects.
• Demonstrate autonomy and use organizational knowledge to resolve inquiries.
• Handle multiple projects and adapt to inventory load.

Conoscenze

Healthcare CS

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Strumenti

Microsoft Access

Descrizione del lavoro

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation and settlement, collaborating with providers, members, and third-party services.

You will use in-depth knowledge of claims processes, internal policies, and regulatory standards to resolve inquiries with autonomy, while supporting a fast-paced call center environment across multiple channels.