Job Description
Note: The job is a remote job and is open to candidates in USA. Humana is a Fortune 100 company committed to putting health first for its teammates and customers. The Claims Research & Resolution Representative 2 will manage claims operations involving customer contact, investigation, and resolution of claims-related financial issues, while performing call center and administrative support assignments.
Responsibilities
- You will take inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues
- You will potentially be making outbound calls regarding case follow-up
- You will record notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly
- You will escalate unresolved and pending customer inquiries
- Decisions you make in this role are typically focused on interpretation of area or department policy and methods for completing assignments
- Our standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion
- You will work within defined parameters to identify work expectations and quality standards, but you will have some latitude over prioritization and timing, and will work with minimal direction
- You will cross-train in all functions within the department
Skills
- 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
- You must have strong technical skills with the ability to work across multiple software systems
- You must be self-reliant, with the ability to resolve issues independently under minimum supervision
- You must have the ability use internal system resources (i.e., Mentor) to find a resolution to an issue and / or respond to an inquiry
- You must have demonstrated time management and prioritization skills
- You must have experience managing multiple or competing priorities
- Requires that you have the capacity to maintain confidentiality while working remotely out of your home
- 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
- Bilingual (Spanish and English; see Language Proficiency Testing information below)
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
Company Overview
Company H1B Sponsorship
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