Claims Research & Resolution Representative

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The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. The position includes 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.

Humana values associate engagement and well-being. We also provide excellent professional development and continued education.

The claims inbound call center is comprised of a group of calls / claims / provider
associates researching the resolution to a pending call. The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the resolution of claims.

Responsibilities include:

• Taking inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues.

• Recording notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly.

• Escalation of unresolved and pending customer inquiries.

• Decisions are typically focused on interpretation of area or department policy and methods for completing assignments.

• Standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion. Work is within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization and timing, and works under minimal direction.

• 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-reliance with the ability to resolve issues independently with 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

• Ability to manage multiple or competing priorities

• Capacity to maintain confidentiality working remotely out of your home

• 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 180 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.

• 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.

• Bachelor's Degree

• Prior claims processing experience

• Overpayment experience

• Financial recovery experience

• Previous experience with Mentor software

• Pre Pay or Post Pay experience

• CAS, CIS or CISPRO experience

• CRM experience

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

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;…