Remote Claims Research & Resolution Specialist

Humana; United States; À distance; USD 43 000 - 56 000; Plein temps

Résumé du poste

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, collaboration with providers, and timely settlements. You will report to the Supervisor, Claims & Research Resolution and support a remote, US-based workflow.

The role requires healthcare customer service experience, call center knowledge, and proficiency with Excel/Word, plus familiarity with Medicare/Medicaid terminology and claims processes.

Qualifications

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

Responsabilités

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Use in-depth knowledge of claims processes to 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

Connaissances

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Outils

Microsoft Access

Description du poste

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, collaboration with providers, and timely settlements. You will report to the Supervisor, Claims & Research Resolution and support a remote, US-based workflow.

The role requires healthcare customer service experience, call center knowledge, and proficiency with Excel/Word, plus familiarity with Medicare/Medicaid terminology and claims processes.