[Remote] Claims Research & Resolution Rep

Note: The job is a remote job and is open to candidates in USA. Humana is a Fortune 100 company committed to putting health first for its teammates and customers. The Claims Research & Resolution Representative 2 will manage claims operations involving customer contact, investigation, and resolution of claims-related financial issues, while performing call center and administrative support assignments.ResponsibilitiesYou will take inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issuesYou will potentially be making outbound calls regarding case follow-upYou will record notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordinglyYou will escalate unresolved and pending customer inquiriesDecisions you make in this role are typically focused on interpretation of area or department policy and methods for completing assignmentsOur standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretionYou 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 directionYou will cross-train in all functions within the departmentSkills1 or more years of Call Center or Telephonic customer service experience (within the past 5 years)Previous healthcare related experience or educationBasic Microsoft Office (Word, Excel, Outlook, and Teams) skillsYou must have strong technical skills with the ability to work across multiple software systemsYou must be self-reliant, with the ability to resolve issues independently under minimum supervisionYou must have the ability use internal system resources (i.e., Mentor) to find a resolution to an issue and / or respond to an inquiryYou must have demonstrated time management and prioritization skillsYou must have experience managing multiple or competing prioritiesRequires that you have the capacity to maintain confidentiality while working remotely out of your homeBachelor's DegreePrior claims processing experienceOverpayment experienceFinancial recovery experiencePrevious experience with Mentor softwarePrePay or Post Pay experienceCAS, CIS or CISPRO experienceCRM experienceBilingual (Spanish and English; see Language Proficiency Testing information below)BenefitsMedical, dental and vision benefits401(k) retirement savings planTime off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)Short-term and long-term disabilityLife insuranceMany other opportunitiesCompany OverviewHumana is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.humana.com.Company H1B SponsorshipHumana has a track record of offering H1B sponsorships, with 282 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.



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