Claims Research & Resolution Representative

Job Description:

Claims Research & Resolution Representative

time type

Full time

posted on

Posted Today

job requisition id

R-374891

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. The Claims Research & Resolution Representative 2 performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments.

• The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the resolution of claims.
• This claims inbound call center is comprised of a group of calls / claims / provider associates researching the resolution to a pending call.
• Decisions are typically focused on interpretation of area / department policy and methods for completing assignments.
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization / timing, and works under minimal direction.
• Follows standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.

Use your skills to make an impact
 

Required Qualifications

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

Required Work Schedule

• Virtual training starts on day one of employment and will run for the first 8 to 10 weeks with a schedule of 8:00 AM to 4:30 PM Eastern, Monday - Friday.
• Attendance is vital for your success; no time off will be allowed during training.
• The initial 120 days of employment as a Claims Research & Resolution Representative 2 constitute an appraisal period.  This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods.
• This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.

Work Hours

• Following training, must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern.
• Overtime may be offered, based on business needs.

Preferred Qualifications

• Bachelor's Degree
• Bilingual (Spanish / English) (see Language Proficiency Testing below)
• 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

Additional Information

**PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT) **  

Work at Home Guidance

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with 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 Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. 

Interview Process

• As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
• Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers.
• Video Prescreen: If you are successful with the text prescreen, you will receive another communication to record a Video Prescreen.
• Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule.
• Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job.
• Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less.

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

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Description of Benefits

Humana offers competitive benefits that support whole-person well-being. Associate benefits include medical, dental, vision benefits, 401(k), paid time off, disability, and life insurance.