[Hiring] Claims Research & Resolution Representative @Humana

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Role Description

Become a part of our caring community and help us put health first. The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. You will perform moderately complex call center, administrative, operational and customer support assignments. Workload is typically semi-routine assignments along with intermediate level math computations. This is an opportunity to work remotely and use your research, resolution and customer service skills to join a Fortune 100 company with a great culture and outstanding benefits.

As a Claims Research & Resolution Representative 2, you will work with insurance companies, providers, members, and collection services in the resolution of claims. Your responsibilities include:

  • Taking inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues.
  • Potentially making outbound calls regarding case follow-up.
  • Recording notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly.
  • Escalating unresolved and pending customer inquiries.
  • Making decisions focused on interpretation of area or department policy and methods for completing assignments.
  • Working within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing.
  • Cross-training in all functions within the department.

Qualifications

  • 1 or more years of Call Center or Telephonic customer service experience (within the past 5 years).
  • Previous healthcare related experience or education.
  • Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills.
  • Strong technical skills with the ability to work across multiple software systems.
  • Self-reliant, with the ability to resolve issues independently under minimum supervision.
  • Ability to use internal system resources (i.e., Mentor) to find a resolution to an issue and/or respond to an inquiry.
  • Demonstrated time management and prioritization skills.
  • Experience managing multiple or competing priorities.
  • Capacity to maintain confidentiality while working remotely out of your home.

Requirements

  • Virtual training starts on day one of employment and will run up to 8 weeks with a schedule of 8:00 AM to 4:30 PM Eastern Time, Monday - Friday.
  • Attendance is vital for your success; no time off will be allowed during training.
  • The initial 180 days of employment constitute an appraisal period requiring perfect attendance during both the classroom training and nesting periods.
  • Willingness to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.
  • Following training, you must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern Time.
  • Overtime may be offered, based on business needs.

Preferred Qualifications

  • 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).

Benefits

  • Competitive benefits that support whole-person well-being.
  • Medical, dental and vision benefits.
  • 401(k) retirement savings plan.
  • Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
  • Short-term and long-term disability.
  • Life insurance and many other opportunities.

Additional Information

  • Work at Home Guidance: Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.
  • Associates who live and work from Home in specific states will be provided a bi-weekly payment for their internet expense.
  • Humana will provide telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  • Language Proficiency Testing: Any associate who speaks with a member in a language other than English must take a language proficiency assessment.
  • Interview Process: We will be using technology called HireVue to enhance our hiring and decision-making ability.
  • Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
  • Scheduled Weekly Hours: 40.
  • Pay Range: $40,000 - $52,300 per year.
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