Claims Processing Representative 3

Profile

Description

The Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

The Claims Processing Representative 3 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Required Qualifications


High School Diploma or equivalent

2 years minimum of institutional claims processing

Knowledge of APC, DRG pricing

Knowledge of Revenue Codes

Strong data entry skills required


Location: Tampa Florida


May be considered for remote work at home after one year upon leader approval.

Hours: Training hours during the first 4 months will be Monday-Friday from 8:00 AM to 4:30pm Eastern Time.

Following Training hours may be worked hours are flexible 8 hours shifts between 6:00 AM to 5:30 PM Eastern


Preferred Qualifications


Medical terminology, CPT-4 and ICD-10 coding & Medicare experience

Experience in medical claims processing

Demonstrated leadership experience (Demonstrated capability with coaching and developing associates formally and informally)


Additional Information

Humana‘s Temporary Remote Work at Home Policy based on CDC Recommendation In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include:

For Interview Purposes:


Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m,

Dedicated secure home workspace for interview or work purposes.


Upon Hire:


Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)

Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy during work hours.

The following equipment will be provided: laptop, Two Monitors, mouse, keyboard, Avaya phone system that connects to laptop, and modem cable to hard wire connect laptop

Humana does not cover reimburse costs to set up a home office, or monthly internet service

The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.


As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact **** for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact **** to validate the request.

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