Call Center and Claims Representative

Humana Inc; Wisconsin; Remote; USD 38,000 - 46,000; Full time

Job summary

Join a forward-thinking company dedicated to putting health first. As a Call Center and Claims Representative, you'll play a vital role in assisting members and providers with inquiries related to benefits and claims. This position offers the opportunity to work remotely while collaborating with a supportive team. With a focus on customer service excellence, you'll help ensure that members receive the information they need in a timely manner. Enjoy a comprehensive benefits package that promotes your well-being and career development, making a meaningful impact on the lives of those you serve.

Benefits

Health benefits effective day 1

Paid time off

401(k) retirement savings plan with employer match

Tuition assistance

Career development opportunities

Qualifications

• 1 year of customer service experience in an inbound call center.
• Knowledge of health insurance processes.

Responsibilities

• Provide program, benefit, eligibility, and claims information to members.
• Manage complaints and route appropriately for resolution.

Skills

Customer Service

Telephone Etiquette

Microsoft Office Products

Education

High School Diploma

Job description

Job Profile

Inbound Contacts Representative 1

Job Level

Representative 1

Become a part of our caring community and help us put health first

Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.

The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes Humana/iCare services to existing, potential and new members via telephone and in writing. This role will also provide responses to provider claim inquiries within the designated timeframes, including claims status, denials, reconsiderations, and explanation of payments.

Essential Duties and Responsibilities

• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer (member or provider) requests and questions are handled appropriately and in a timely manner.
• Provides support, guidance, direction & limited education to providers on member eligibility, authorizations, Humana/iCare guidelines and provider portal.
• Provides limited authorization information of referrals to providers and members.
• Researches issues and uses judgment for obtaining relevant information.
• Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system.
• Consistently meets individual performance and quality goals.
• Adheres to Company policy guidelines.
• Actively participates in department/company meetings.
• Manages complaints/grievances/appeals and route appropriately for research and resolution.

Use your skills to make an impact

Required Qualifications

• One (1) year of demonstrated customer service experience in an inbound call center setting with knowledge of appropriate telephone etiquette.
• One (1) year of experience in health insurance.
• Experienced with Microsoft Office Products.

Preferred Qualifications

• Previous experience in Medicaid and/or Medicare customer service and/or claims processing.
• Bi-lingual English/Spanish.
• Ability to type at least 40 WPM. (Test your typing speed for free online)
• Experience working in a managed health care setting.
• Resides in Wisconsin.

Additional Information

• Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
• Typical Work Days/Hours: must be available Monday through Friday; 8:00am – 5:00 pm (CST)

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

HireVue

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.

Nationwide Remote - This is a remote nationwide position.

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.$38,000 - $45,800 per year

Referral Bonus Information

This requisition is not eligible for a referral bonus.

About us

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.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.