Claims Research & Resolution Representative

🔥 0 minutes ago

🏈 Alabama, Alaska, +42 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Manage claims operations involving customer contact, investigation, and resolution of claims or claims-related financial issues • Take inbound calls addressing customer needs, including complex financial recovery, questions, and issue resolution • Potentially make outbound calls for case follow-up • Record notes detailing inquiries, comments, complaints, transactions, and interactions • Take appropriate action based on recorded information • Escalate unresolved and pending customer inquiries • Interpret department policies and methods for completing assignments • Identify work expectations and quality standards within defined parameters • Prioritize work and manage timing with minimal direction • Cross-train in all department functions • Work with insurance companies, providers, members, and collection services to resolve claims • Complete virtual training for up to 8 weeks • Attend classroom training and nesting periods with perfect attendance during the initial 180-day appraisal period

🎯 Requirements

• One (1) or more years of Call Center or Telephonic customer service experience within the past 5 years • Previous healthcare related experience or education • Basic Microsoft Office skills, including Word, Excel, Outlook, and Teams • Strong technical skills with the ability to work across multiple software systems • Ability to resolve issues independently under minimum supervision • Ability to use internal system resources, such as Mentor, to find resolutions or respond to inquiries • Demonstrated time management and prioritization skills • Experience managing multiple or competing priorities • Ability to maintain confidentiality while working remotely from home • Ability to work an assigned 8-hour shift between 8:00 AM and 6:00 PM Eastern Time after training • Willingness to remain in the position for twelve (12) months before applying to other Humana opportunities • Dedicated home workspace without ongoing interruptions to protect member PHI/HIPAA information • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Preferred: Bachelor's Degree • Preferred: Prior claims processing experience • Preferred: Overpayment experience • Preferred: Financial recovery experience • Preferred: Mentor software experience • Preferred: PrePay or Post Pay experience • Preferred: CAS, CIS, or CISPRO experience • Preferred: CRM experience • Resume attached in PDF or Word format

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Professional development • Continued education • Remote work • Overtime may be offered based on business needs