Claims Research & Resolution Lead

Are you a problem solver with a passion for helping others? Do you have experience in claims research and resolution? Humana is seeking a highly motivated and detail-oriented individual to join our team as a Claims Research & Resolution Lead. In this role, you will be responsible for investigating and resolving complex claims issues, ensuring accuracy and timely resolution for our members. If you possess strong analytical skills, excellent communication abilities, and a commitment to superior customer service, we want to hear from you!

1. Conduct thorough research on complex claims issues to determine root causes and potential resolutions.
2. Analyze data and documentation to identify patterns and trends in claims processing.
3. Utilize critical thinking skills to develop creative and effective solutions for claims issues.
4. Communicate with members, providers, and other stakeholders to gather additional information and provide updates on claim status.
5. Lead a team of claims resolution specialists, providing guidance and support to ensure timely and accurate resolution of claims.
6. Collaborate with other departments, such as billing and coding, to ensure claims are processed correctly and accurately.
7. Maintain accurate and organized records of claims research and resolution activities.
8. Identify opportunities for process improvement and work with team members to implement solutions.
9. Stay updated on industry changes and regulations related to claims processing and insurance policies.
10. Uphold company values of integrity, empathy, and excellence in all interactions with members and colleagues.

According to JobzMall, the average salary range for a Claims Research & Resolution Lead is between $53,000 and $82,000 per year. However, this can vary depending on factors such as location, experience, and the specific company and industry.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.