Claims Research & Resolution Representative

Humana

1d • $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 the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. The Claims Research & Resolution Representative 3 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Requirements

• 1+ years of call center or related customer service experience
• Capacity to maintain confidentiality
• Must reside in the United States
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Bachelor's Degree
• Prior claims processing experience
• Knowledge of healthcare terminology

Responsibilities

• Manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization.
• Approves all claim settlements both for and against the organization.
• Performs advanced administrative/operational/customer support duties that require independent initiative and judgment.
• Works with insurance companies, providers, members, and collection services in the settlement of claims.
• Researches the resolution to a pending call.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, 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: Associate degree