Claims Research / Resolution Representative 2 Phone-A-Friend - WAH Tampa FL

Profile

Description

The Claims Research and Resolution Representative 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research and Resolution Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Claims Research and Resolution Representative 2 does the following:


Provides friendly and effective customer service via phone approximately half of the work day and processes claims out of a queue the other half of the day
Determines whether to deny or pay claims following organizational policies and procedures.
Handles inbound/outbound claims call on a daily basis
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.
Works within a professional environment with production matrix set based on assigned team.


The ideal candidate approaches their work with integrity and excellence and strives to make customers happy through every interaction.

Work Environment: Please note this position allows you to work at home indefinitely until further notice; there is a possibility of this opportunity returning to a physical office at a future date to be determined by leadership. See the Additional Information section below.

Benefits and Perks of This Opportunity


Extensive training - at least 5 weeks!!
Bonus eligibility based on individual and company performance
Work on a highly engaged team with plenty of growth opportunities
Gain highly transferable and competitive skills
The chance to be empowered and have a lot of decision-making ability in your work


Required Qualifications


High School Diploma or equivalent
Proficiency in Microsoft Word, PowerPoint and Excel as well as comfortable working within multiple programs and systems daily
Analytical thinking skills and comfortable working independently and with minimal supervision
Excellent verbal and written communication skills
The ability to work professionally and within designated time frames
The ability and willingness to work any shift between 6:00 a.m. and 5:30 p.m EST Monday through Friday with the flexibility to work weekends and/or mandatory overtime based on business needs
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Bachelor's Degree
1 years of experience working within a similar environment
1 years of experience within the healthcare and/or Insurance industries
Knowledge and experience with claims management especially CAS Claims processing, CPU (CMS Processing Unit) cases, and/or claims management systems
Prior Billing and Enrollment experience for CI/CAS/MTV
Proficient in Microsoft Access


Additional Information


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 access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. 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. #ThriveTogether #WorkAtHome
This position may deploy to the following physical location at a future date: 5701 East Hillsborough Avenue, Suite 2100, Tampa, FL 33610. Further guidance to be provided by Leadership.
This position offers 5 weeks of training. Please note that training is a critical stage of associate development. Any time off or scheduled obligations during the training period will need to be reviewed as part of the selection process.
Overtime is generally voluntary but may be mandatory based on business needs. We strive to provide a minimum of a week advance notice if you need to work OT hours


Scheduled Weekly Hours

40

Company info

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