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[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.
