Remote Healthcare Claims Resolution Specialist

Humana Inc; Austin (TX); À distance; USD 43 000 - 56 000; Plein temps

Résumé du poste

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage complex medical claims from investigation through settlement. You will work with providers, members, and third-party services to resolve issues, ensuring compliance with policies and regulations.

Training lasts eight weeks with Monday–Friday, 8:00am–4:30pm EST. After training, you may work any shift Monday–Friday, 6:00am–5:30pm EST, with occasional travel for meetings.

Qualifications

• 1 or more years of Healthcare customer service experience.
• 1 or more years of call center experience.
• Intermediate Excel skills.
• Intermediate proficiency Word.
• Working knowledge of healthcare terminology.
• Working knowledge of Medicare or Medicaid claims.

Responsabilités

• 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 in resolving claims inquiries.
• Handle support requests across multiple channels based on inventory load.

Connaissances

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Outils

Microsoft Access

Description du poste

Humana Inc. seeks a Claims Research & Resolution Representative 3 to manage complex medical claims from investigation through settlement. You will work with providers, members, and third-party services to resolve issues, ensuring compliance with policies and regulations.

Training lasts eight weeks with Monday–Friday, 8:00am–4:30pm EST. After training, you may work any shift Monday–Friday, 6:00am–5:30pm EST, with occasional travel for meetings.