Claims Research Resolution Rep

Humana • Washington, NV

3d • $43,000 - $56,200 • Remote

About The Position

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 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 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 experience handling support requests from a variety of different channels, based on inventory load.

Requirements

• 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

Nice To Haves

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

Responsibilities

• 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 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 experience handling support requests from a variety of different channels, based on inventory load.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed