Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Paid time off

Parental leave

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to work remotely, handling complex medical claims with providers, members, and third-party services. You will investigate discrepancies, verify documentation, and ensure policy compliance, reporting to the Supervisor, Claims & Research Resolution.

Training is virtual for 8 weeks (Mon–Fri, 8:00am–4:30pm EST). After training, shifts run Mon–Fri, 6:00am–5:30pm EST, with an 18-month commitment and possible travel to Humana offices for

Qualifications

• 1+ year of healthcare customer service experience.
• 1+ year 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

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Tools

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to work remotely, handling complex medical claims with providers, members, and third-party services. You will investigate discrepancies, verify documentation, and ensure policy compliance, reporting to the Supervisor, Claims & Research Resolution.

Training is virtual for 8 weeks (Mon–Fri, 8:00am–4:30pm EST). After training, shifts run Mon–Fri, 6:00am–5:30pm EST, with an 18-month commitment and possible travel to Humana offices for