Remote Claims Research Specialist

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

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third‑party services. You will investigate discrepancies, verify documentation, and ensure regulatory and internal policy compliance.

Reporting to the Supervisor, Claims & Research Resolution, the role requires 1+ year of healthcare customer service and call-center experience, plus intermediate Excel and Word skills.

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.
• Investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with claims, call center, and provider teams to research pending claims issues.
• Apply advanced judgment to determine methods and workflows for managing administrative tasks and projects.
• Demonstrate autonomy, using experience to resolve claims inquiries.
• Handle multiple projects and channels based on inventory load.

Skills

Healthcare CS

Call center

Medicare/Medicaid claims

Healthcare terminology

Member reimbursement

Medicare industry

Benefits knowledge

Education

Bachelor’s degree or equivalent

Tools

Excel

Word

Access

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage complex medical claims with providers, members, and third‑party services. You will investigate discrepancies, verify documentation, and ensure regulatory and internal policy compliance.

Reporting to the Supervisor, Claims & Research Resolution, the role requires 1+ year of healthcare customer service and call-center experience, plus intermediate Excel and Word skills.