[Remote] Claims Research and Resolution Professional at Humana

The Claims Research and Resolution Professional will track and trend claims data for providers in the IL FIDE network to identify denial and rework root causes, and conduct root cause analyses of claims denials, rework, underpayments, and errors. They will collaborate with Provider Relations to deliver training on claims denials, rejections, and underpayments, and assist with claims submission expectations, including code edits, remittance review, and overpayment processes. This role involves contributing to provider training on appropriate claim submission and monitoring provider behaviors post-training to ensure resolution of claim denial root causes, escalating internal system issues, and assisting with content creation for billing forums. The professional will also partner with Provider Relations Representatives to resolve provider inquiries and concerns related to claims payment, submit and monitor Business Case Justification and Incorrect Payment Audit Requests, and assist with the development and distribution of provider communications and educational materials.