Claims Research & Resolution Representative

Welcome to Humana, where our mission is to help people achieve lifelong well-being. We are currently seeking a dedicated and detail-oriented Claims Research & Resolution Representative to join our team. As a member of our organization, you will play a crucial role in ensuring our members receive accurate and timely resolution for their claims inquiries. This position requires strong analytical skills, exceptional communication, and a passion for providing excellent customer service. If you are committed to making a positive impact in people's lives and have the qualifications we are looking for, we invite you to apply and join our Humana family.

1. Conduct thorough research and analysis of member claims inquiries to determine the appropriate resolution.
2. Collaborate with other departments and team members to gather necessary information and resolve complex claims issues.
3. Communicate with members, providers, and other stakeholders in a professional and timely manner to provide updates and resolve any issues related to claims.
4. Maintain accurate and detailed records of all claims inquiries, resolutions, and communication for future reference.
5. Ensure compliance with all relevant regulations, policies, and procedures while processing claims.
6. Work efficiently and effectively to meet individual and team performance metrics and goals.
7. Provide exceptional customer service by actively listening to and addressing members' concerns and questions related to their claims.
8. Continuously identify and implement process improvement opportunities to enhance the overall claims resolution experience for members.
9. Stay updated on industry trends and best practices related to claims processing and customer service.
10. Attend training sessions and meetings to stay informed on company updates, policies, and procedures.
11. Uphold Humana's mission of helping people achieve lifelong well-being through all interactions with members and colleagues.
12. Perform any other duties or responsibilities as assigned by the supervisor or manager.

According to JobzMall, the average salary range for a Claims Research & Resolution Representative in Atlanta, GA, USA is between $40,000 - $60,000 per year. However, this can vary depending on factors such as experience, education, and the specific company or 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.