Senior Claims Research & Resolution Specialist

Humana; New Hampshire; Remote; USD 43,000 - 56,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement plan

Paid time off

Parental leave

Disability insurance

Life insurance

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement activities. You will report to the Supervisor, Claims & Research Resolution.

The role emphasizes collaboration with providers, members, and third-party services to resolve complex medical claims efficiently. Training is eight weeks full-time, Monday–Friday 8:00am–4:30pm EST, followed by a Monday–Friday shift schedule 6:00am–5:30pm EST.

Qualifications

• 1+ years of healthcare customer service experience.
• 1+ years of call center experience.
• Intermediate Excel and Word proficiency.
• 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 judgment to determine methods, strategies, and workflows for administrative tasks and projects.
• Demonstrate autonomy using experience and knowledge to resolve claims inquiries.
• Handle diverse support requests across multiple channels based on inventory load.

Skills

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations, including customer contact, investigation, and settlement activities. You will report to the Supervisor, Claims & Research Resolution.

The role emphasizes collaboration with providers, members, and third-party services to resolve complex medical claims efficiently. Training is eight weeks full-time, Monday–Friday 8:00am–4:30pm EST, followed by a Monday–Friday shift schedule 6:00am–5:30pm EST.