Healthcare Claims Denials Specialist

At Humana, we believe that every person deserves access to quality healthcare. As a Healthcare Claims Denials Specialist, you will play a vital role in ensuring that our members receive the coverage they need and deserve. We are looking for a dedicated and detail-oriented individual who is passionate about making a positive impact in the healthcare industry. If you have excellent problem-solving skills, strong communication abilities, and a thorough understanding of claims processing and reimbursement, we want you on our team. Join us at Humana and help us continue to provide exceptional care to our members. Review and analyze healthcare claims to identify potential denials and discrepancies. Work closely with insurance providers, healthcare providers, and members to resolve claim denials and ensure proper reimbursement. Conduct thorough research and investigations to determine the root cause of denials and develop strategies to prevent future denials. Communicate with healthcare providers and insurance companies to gather necessary information and documentation for claims appeals. Utilize knowledge of medical coding and billing procedures to accurately process claims and ensure compliance with industry regulations. Collaborate with cross-functional teams, including customer service, billing, and finance, to resolve complex claims issues. Maintain accurate and up-to-date records of claim denials, appeals, and resolutions. Identify opportunities for process improvement and work with management to implement effective solutions. Stay current on industry changes and updates related to claims processing and reimbursement. Uphold Humana's mission of providing quality healthcare to all members and promote a positive company image. Humana is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.