Claims Processing Representative

OneHome; Town of Florida (NY); On-site; USD 40,000 - 52,000; Full time

Job summary

OneHome, a Humana affiliate, seeks a Claims Processing Representative to review and adjudicate complex or specialty claims, submitted on paper or electronically. This in-office role is based at our Miramar, FL location and involves semi-routine administrative and customer support tasks.

You will determine whether to return, deny, or pay claims following policies; essential qualifications include less than 3 years of tech experience, MS Office proficiency, and health plan claims processing

Qualifications

• Less than 3 years of technical experience.
• Proficiency in Word, PowerPoint, Excel, and Access.
• Health plan claims processing experience.
• Passionate about contributing to an organization focused on continuously improving consumer experiences.

Responsibilities

• Reviews and adjudicates complex or specialty claims.
• Performs computations and supports semi-routine assignments.
• Determines whether to return, deny, or pay claims following organizational policies.

Skills

Tech experience <3y

MS Office proficiency

Claims processing

Customer experience focus

Education

Bachelor's Degree

Job description

Become a part of our caring community

The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Become a part of our caring community

The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

This is in office position requires you to be on site at our Miramar, FL branch location.

The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Required Qualifications

Use your skills to make an impact

• Less than 3 years of technical experience
• Proficiency in all Microsoft Office: Word, PowerPoint, Excel, and Access
• Health plan claims processing experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Bachelor's Degree
• Quality background
• Prior Billing and Enrollment experience
• CPU (CMS Processing Unit) case knowledge

Additional Information

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.

$40,000 - $52,300 per year

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers 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 while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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.