[Hiring] Claims Research Resolution Representative @Humana

Role Description

The Claims Research & Resolution Representative 3 manages claims operations that involve customer contact, investigation, and settlement of claims for and against our organization. You will report to the Supervisor, Claims & Research Resolution.

As the Claims Research & Resolution Representative 3 you will:

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with a specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, based on business needs, with the ability to handle support requests from a variety of different channels, based on inventory load.

Qualifications

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

Requirements

• Healthcare call center experience (preferred)
• Working knowledge with Microsoft Access (preferred)
• Medical claims processing experience (preferred)
• Member reimbursement experience (preferred)
• Medicare industry knowledge (preferred)
• Healthcare Benefit knowledge (preferred)

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off, including company and personal holidays
• Paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.