[Hiring] Consumer Service Operations Professional 1 @Humana

Role Description

Become a part of our caring community and help us put health first. You will perform installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. You will investigate and settle claims and customer service issues. You will report to a Manager of Business Intelligence.

• Research customer inquiries to resolve claims issues, provide updates to business partners and leadership.
• Document and track issues relating to financial, system and beneficiary data.
• Coordinate and present research findings to internal and external customers.
• Make recommendations based on root cause analysis related to policies, procedures, claims, provider, and beneficiary data.

Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 3 years of experience in managed care environment.
• 3 years of claims experience processing/adjudicating professional, inpatient, and outpatient claims.
• Experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement.
• 2 years of customer service experience.
• Familiarity with reimbursement terminology (ie DME, DRG, HCPCS, CPT coding, Revenue codes, etc).

Requirements

• 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.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family.
• 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 and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.