Claims Research & Resolution Representative
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The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. The position includes moderately complex call center, administrative, operational and customer support assignments. Workload is typically semi-routine assignments along with intermediate level math computations. This is an opportunity to work remotely and use your research, resolution and customer service skills to join a Fortune 100 company with a great culture and outstanding benefits. Humana values associate engagement and well-being. We also provide excellent professional development and continued education.The Claims inbound call center is comprised of a group of calls / claims / provider associates researching the resolution to a pending call. As a Claims Research & Resolution Representative 2, you will work with insurance companies, providers, members, and collection services in the resolution of claims. Your responsibilities include:- You will take inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues.
- You will potentially be making outbound calls regarding case follow-up.
- You will record notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly.
- You will escalate unresolved and pending customer inquiries.
- Decisions you make in this role are typically focused on interpretation of area or department policy and methods for completing assignments.
- Our standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion. You will work within defined parameters to identify work expectations and quality standards, but you will have some latitude over prioritization and timing, and will work with minimal direction.
- You will cross-train in all functions within the department.
Use your skills to make an impact
Required Qualifications
- 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 (Word, Excel, Outlook, and Teams) skills
- You must have strong technical skills with the ability to work across multiple software systems
- You must be self-reliant, with the ability to resolve issues independently under minimum supervision
- You must have the ability to use internal system resources (i.e., Mentor) to find a resolution to an issue and / or respond to an inquiry
- You must have demonstrated time management and prioritization skills
- You must have experience managing multiple or competing priorities
- Requires that you have the capacity to maintain confidentiality while working remotely out of your home
Training
- Virtual training starts on day one of employment and will run up to 8 weeks with a schedule of 8:00 AM to 4:30 PM Eastern Time, Monday - Friday.
- Attendance is vital for your success; no time off will be allowed during training.
- The initial 180 days of employment as a Claims Research & Resolution Representative 2 constitute an appraisal period. This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods.
- This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities.
- Following training, you must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern Time.
- Overtime may be offered, based on business needs.
- Bachelor's Degree
- Prior claims processing experience
- Overpayment experience
- Financial recovery experience
- Previous experience with Mentor software
- PrePay or Post Pay experience
- CAS, CIS or CISPRO experience
- CRM experience
PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT)
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$40,000 - $52,300 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.Application Deadline: 08-31-2026
About us
About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.
Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
