Job Details

Claims Research and Resolution Specialist II -- REMOTE

Company name
Humana Inc.

Jersey City, NJ, United States

Employment Type

Call Center

Posted on
May 05, 2021

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The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.


Where you Come In

The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.


Required Qualifications - What it Takes to Succeed

Minimum of 1 year of Call Center experience - this is an inbound call center role

Ability to interact with members, agents and/or providers by phone

Proficient in Microsoft Office: Word, Excel and Outlook

Must be able to work any shift between the hours of 8am - 6pm EST (Monday - Friday)

Core Business Hours align to Eastern Standard Time

Capacity to maintain confidentiality

Passionate about problem solving and providing resolution to customers via a fast paced phone environment

Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Work-At-Home Requirements

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Preferred Qualifications

Bachelor's Degree

Previous CAS, MTV or claims processing experience

Previous Financial Recovery experience

Working of knowledge of Medicaid processes

Additional Information

Training: Humana offers virtual training for the first 10-11 weeks following start. Attendance is vital for your success.

At Humana, we know your well-being is important to you, and it's important to us too. We are committed in making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share a real passion for helping people, we likely have the right place for you at Humana. The following policy applies only to associates working in the state of Arizona: We are committed in providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, we have adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Scheduled Weekly Hours


Company info

Humana Inc.
Website :

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