Claims Research & Resolution Representative
Posted 3ds ago
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Job Description
Claims representative researching and resolving customer and provider healthcare claims for Humana. Handling inbound calls, financial recovery issues, documentation, and escalations remotely.
Responsibilities:
- Manage claims operations involving customer contact, investigation, and resolution of claims or claims-related financial issues
- Take inbound calls addressing customer needs, including complex financial recovery, questions, and issue resolution
- Potentially make outbound calls for case follow-up
- Record notes detailing inquiries, comments, complaints, transactions, and interactions
- Take appropriate action based on recorded information
- Escalate unresolved and pending customer inquiries
- Interpret department policies and methods for completing assignments
- Identify work expectations and quality standards within defined parameters
- Prioritize work and manage timing with minimal direction
- Cross-train in all department functions
- Work with insurance companies, providers, members, and collection services to resolve claims
- Complete virtual training for up to 8 weeks
- Attend classroom training and nesting periods with perfect attendance during the initial 180-day appraisal period
Requirements:
- One (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 skills, including Word, Excel, Outlook, and Teams
- Strong technical skills with the ability to work across multiple software systems
- Ability to resolve issues independently under minimum supervision
- Ability to use internal system resources, such as Mentor, to find resolutions or respond to inquiries
- Demonstrated time management and prioritization skills
- Experience managing multiple or competing priorities
- Ability to maintain confidentiality while working remotely from home
- Ability to work an assigned 8-hour shift between 8:00 AM and 6:00 PM Eastern Time after training
- Willingness to remain in the position for twelve (12) months before applying to other Humana opportunities
- Dedicated home workspace without ongoing interruptions to protect member PHI/HIPAA information
- Home internet with at least 25 Mbps download and 10 Mbps upload speed
- Preferred: Bachelor's Degree
- Preferred: Prior claims processing experience
- Preferred: Overpayment experience
- Preferred: Financial recovery experience
- Preferred: Mentor software experience
- Preferred: PrePay or Post Pay experience
- Preferred: CAS, CIS, or CISPRO experience
- Preferred: CRM experience
- Resume attached in PDF or Word format
Benefits:
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Professional development
- Continued education
- Remote work
- Overtime may be offered based on business needs
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