Claims Research Resolution Rep

The Claims Research & Resolution Representative 3 manages claims operations that involve customer contact, investigation, and settlement of claims for and against our organization. You will report the Supervisor, Claims & Research Resolution.

As the Claims Research & Resolution Representative 3 you will

• 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

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

• Healthcare call center experience
• Working knowledge with Microsoft Access
• Medical claims processing experience
• Member reimbursement experience
• Medicare industry
• Healthcare Benefit knowledge

• Virtual training and runs for 8 weekswith a schedule of Monday – Friday, 8:00am – 4:30pm EST.
• Attendance is vital for success; other than Humana-observed holidays,
  no time off is allowed during training or during your first 120 days of employment.
• You must be on time, dressed appropriately, with your camera ON for the entire duration of training, nesting, and for other meetings required by leadership.

• Following training,
  you
  must be able to work
  any
  shift
  Monday – Friday, between the hours of 6:00am – 5:30pm EST .
• You will learn many systems, policies, and tools, and it takes times to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities outside of this team.
• Requires an 18 month time in job commitment

Work at Home Requirements:
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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

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,…