Claims Research and Resolution Professional 2 - Remote

Overview

Become a part of our caring community and help us put health first. Humana Fully Integrated Dually Eligible (HMO D-SNP) in IL is seeking a Claims Research & Resolution Professional 2 claims educator, responsible for minimizing claims denials through education and training.

In Short

• Track and trend IL FIDE D-SNP claims data.
• Conduct root cause analyses of claims denials and errors.
• Support Provider Relations team with claims submission processes.
• Identify and address recurring claims issues.
• Conduct training on claims submission and common errors.
• Assist in developing provider communications and educational materials.
• Collaborate with internal teams for issue resolution.
• Monitor compliance with Medicaid regulations.
• Work remotely with occasional travel for training.
• Eligible for a bonus incentive plan based on performance.

Requirements

• 2+ years of health insurance claims experience.
• Experience with IL Medicaid and FIDE D-SNP.
• Exceptional time management skills.
• Experience analyzing claims data.
• Bachelor's degree preferred.
• 3+ years working knowledge of claims systems.
• Knowledge of Medicaid reform and regulatory requirements.
• Intermediate to advanced skills in MS Office.
• Excellent written and verbal communication skills.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability benefits.
• Life insurance.
• Support for personal wellness and healthcare decisions.