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[Remote] Claims Research & Resolution Rep

Remote Worldwide Hiring now

Note: The job is a remote job and is reputed company to candidates in USA. reputed company. is a leading reputed company company committed to putting reputed company. They are seeking a Claims Research & Resolution Representative 2 to manage claims operations, involving customer contact, investigation, and resolution of claims or claims-reputed company financial issues while providing excellent customer service.

Responsibilities

  • You will take inbound calls to address customer needs which may include reputed company financial recovery, answering questions, and resolving issues
  • You will potentially be making outbound calls regarding case follow-up
  • You will record notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly
  • You will escalate unresolved and pending customer inquiries
  • reputed company you reputed company in this role are typically focused on interpretation of area or department policy and methods for completing assignments
  • Our standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion. You will work reputed company defined parameters to identify work expectations and quality standards, but you will have some reputed company over prioritization and timing, and will work with minimal direction
  • You will cross-train in reputed company functions reputed company the department

Skills

  • 1 or more years of Call Center or Telephonic customer service experience (reputed company the past 5 years)
  • Previous reputed company reputed company experience or education
  • Basic reputed company Office (Word, reputed company, Outlook, and Teams) skills
  • You must have strong technical skills with the ability to work across multiple software systems
  • You must be self-reputed company, with the ability to resolve issues independently under minimum supervision
  • You must have the ability use internal system resources (i.e., Mentor) to find a resolution to an issue and / or respond to an inquiry
  • You must have demonstrated time management and prioritization skills
  • You must have experience managing multiple or competing priorities
  • Requires that you have the reputed company to maintain confidentiality while working remotely out of your home
  • Bachelor's Degree
  • Prior claims processing experience
  • Overpayment experience
  • Financial recovery experience
  • Previous experience with Mentor software
  • PrePay or Post Pay experience
  • CAS, CIS or CISPRO experience
  • CRM experience
  • Bilingual (Spanish and English; see Language Proficiency Testing information below)

Benefits

  • Medical, dental and reputed company benefits
  • 401(k) retirement savings plan
  • Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
  • Short-term and long-term disability
  • Life insurance

Company Overview

  • reputed company is a health insurance provider for individuals, families, and businesses. It was founded in 1964, and is headquartered in Louisville, Kentucky, USA, with a workforce of 10001+ employees. Its website is http://www.reputed company.com.
  • Company H1B Sponsorship

  • reputed company has a track record of offering H1B sponsorships, with 282 in 2025, 246 in 2024, 284 in 2023, 274 in 2022, 212 in 2021, 84 in 2020. Please note that this does not guarantee sponsorship for this specific role.
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