Remote Claims Research & Resolution Specialist

Humana; Utah; Teletrabalho; USD 43 000 - 56 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Paid time off

Holidays

Parental leave

Caregiver leave

Disability insurance

Life insurance

Resumo da oferta

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

Training is 8 weeks, Monday–Friday, 8:00am–4:30pm EST, with attendance essential during training and the first 120 days. After training, you may work any shift Monday–Friday, 6:00am–5:30pm EST, with travel to Humana offices occasionally for training/meetings.

Qualificações

• 1+ years of healthcare customer service experience
• 1+ years of call center experience
• Intermediate Excel skills
• Intermediate proficiency Word
• Working knowledge of healthcare terminology
• Working knowledge of Medicare or Medicaid claims

Responsabilidades

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries.
• Pivot quickly from one project to the next, based on business needs, with the ability to experience handling support requests from a variety of different channels, based on inventory load

Conhecimentos

Healthcare customer service

Call center

Excel

Word

Healthcare terminology

Medicare/Medicaid claims

Descrição da oferta de emprego

Humana is seeking a Claims Research & Resolution Representative 3 to manage claims operations involving customer contact, investigation, and settlement. You will report to the Supervisor, Claims & Research Resolution.

Training is 8 weeks, Monday–Friday, 8:00am–4:30pm EST, with attendance essential during training and the first 120 days. After training, you may work any shift Monday–Friday, 6:00am–5:30pm EST, with travel to Humana offices occasionally for training/meetings.