Claims Research & Resolution Representative

Become a part of our caring community 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.

• 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 elevate 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.

• 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