Claims Research & Resolution Representative

Welcome to Humana, a leading healthcare company dedicated to improving the lives of our members. We are currently seeking a highly motivated and detail-oriented Claims Research & Resolution Representative to join our team. In this role, you will be responsible for investigating and resolving complex claims issues, ensuring accurate and timely payments to our members and providers. As a vital member of our team, you will have the opportunity to make a positive impact on the lives of our members and contribute to the success of our organization. To excel in this position, you must have strong analytical skills, excellent communication abilities, and a passion for providing exceptional customer service. Join us and help us fulfill our mission of making healthcare more accessible and affordable for all.

1. Investigate and resolve complex claims issues to ensure accurate and timely payments to members and providers.
2. Utilize analytical skills to identify and resolve discrepancies in claims data.
3. Communicate with members, providers, and internal teams to gather information and resolve claims issues.
4. Review and process claims in accordance with company policies and procedures.
5. Maintain accurate and detailed records of claims investigations and resolutions.
6. Collaborate with other team members to continuously improve processes and procedures.
7. Provide exceptional customer service to members and providers, addressing any questions or concerns regarding claims.
8. Stay up-to-date on industry regulations and company policies to ensure compliance.
9. Identify trends and patterns in claims data to proactively address and prevent potential issues.
10. Meet productivity and quality standards as set by the company.
11. Participate in training and development opportunities to improve skills and knowledge.
12. Act as a brand ambassador for Humana, representing the company in a positive and professional manner.
13. Contribute to the overall success of the organization by actively supporting the company's mission and values.
14. Adhere to strict confidentiality guidelines when handling sensitive information.
15. Prioritize and manage workload to ensure timely resolution of claims.

According to JobzMall, the average salary range for a Claims Research & Resolution Representative is between $35,000 and $60,000 per year. This can vary depending on factors such as location, experience, and the specific company or industry the representative works in. Some may earn higher salaries with bonuses and other benefits included.

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.