Senior Claims Research & Resolution Specialist

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

Benefits offered by this job

Medical benefits

401(k)

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement.

You will work with providers, members, and third-party services to resolve complex claims, using knowledge of claims processes and internal policies. The role includes training for 8 weeks, then shifts Monday–Friday with early mornings, and occasional travel to Humana offices 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.

Responsibilities

• Collaborate with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy compliance.
• Partner with claims, call center, and provider teams to resolve pending claims.
• Apply judgment to select methods and workflows for handling tasks.
• Demonstrate autonomy and leverage knowledge to resolve inquiries.
• Handle multiple projects and channels per business needs.

Skills

Healthcare customer service

Call center experience

Excel

Word

Healthcare terminology

Medicare/Medicaid claims knowledge

Job description

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement.

You will work with providers, members, and third-party services to resolve complex claims, using knowledge of claims processes and internal policies. The role includes training for 8 weeks, then shifts Monday–Friday with early mornings, and occasional travel to Humana offices for meetings.