Remote Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical, dental, vision

401(k) retirement

Paid time off

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement of medical claims. You will report to the Supervisor, Claims & Research Resolution, and collaborate with providers, members, and third-party services to resolve complex issues.

Training runs eight weeks, Monday–Friday, 8:00am–4:30pm EST, with strict attendance during training and nesting.

Qualifications

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

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy compliance.
• Collaborate with claims, call center, and provider teams to resolve issues.
• Apply judgment to determine methods and workflows for managing tasks.
• Operate autonomously to resolve inquiries across channels.

Skills

Healthcare customer service

Call center experience

Healthcare terminology

Medicare/Medicaid claims

Tools

Excel

Word

Microsoft Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement of medical claims. You will report to the Supervisor, Claims & Research Resolution, and collaborate with providers, members, and third-party services to resolve complex issues.

Training runs eight weeks, Monday–Friday, 8:00am–4:30pm EST, with strict attendance during training and nesting.