Remote Claims Research & Resolution Specialist

Humana; Virginia; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, documentation verification, and settlements. You will work with providers, members, and third-party services, reporting to the Supervisor, Claims & Research Resolution.

The role emphasizes autonomy and specialized collaboration across claims, call center, and provider teams to resolve inquiries while adhering to internal policies and regulatory standards.

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.
• 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

Skills

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims through investigation, documentation verification, and settlements. You will work with providers, members, and third-party services, reporting to the Supervisor, Claims & Research Resolution.

The role emphasizes autonomy and specialized collaboration across claims, call center, and provider teams to resolve inquiries while adhering to internal policies and regulatory standards.