[Hiring] Claims Research & Resolution Rep @Humana

Role Description

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. 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.

• Take inbound calls to address customer needs, including complex financial recovery, answering questions, and resolving issues.
• Make outbound calls regarding case follow-up.
• Record notes with details of inquiries, comments or complaints, transactions or interactions and take action accordingly.
• Escalate unresolved and pending customer inquiries.
• Make decisions focused on interpretation of area or department policy and methods for completing assignments.
• Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing.
• Cross-train 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.
• 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 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.

Benefits

• Medical, dental and vision 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.
• Many other opportunities.

Interview Process

• Use of technology called HireVue to enhance hiring and decision-making ability.
• Text Prescreen: You may receive a text message and email requesting you to complete prescreen questions.
• Video Prescreen: Successful candidates will record a Video Prescreen using their phone, tablet, or computer.
• Interviews: Some candidates will be invited to interview.
• Offers: Finalists will be contacted by a recruiter to discuss an offer for the job.

Scheduled Weekly Hours

• 40 hours per week.

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