[Remote] Claims Research & Resolution Rep

Note: The job is a remote job and is open to candidates in USA. Humana is a Fortune 100 company committed to putting health first for its teammates and customers. The Claims Research & Resolution Representative 2 will manage claims operations involving customer contact, investigation, and resolution of claims-related financial issues, while performing call center and administrative support assignments.

Responsibilities

• You will take inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues
• You will potentially be making outbound calls regarding case follow-up
• You will record notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly
• You will escalate unresolved and pending customer inquiries
• Decisions you make in this role are typically focused on interpretation of area or department policy and methods for completing assignments
• Our standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion
• You will work within defined parameters to identify work expectations and quality standards, but you will have some latitude over prioritization and timing, and will work with minimal direction
• You will cross-train in all functions within the department

Skills

• 1 or more years of Call Center or Telephonic customer service experience (within the past 5 years)
• Previous healthcare related experience or education
• Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills
• You must have strong technical skills with the ability to work across multiple software systems
• You must be self-reliant, with the ability to resolve issues independently under minimum supervision
• You must have the ability use internal system resources (i.e., Mentor) to find a resolution to an issue and / or respond to an inquiry
• You must have demonstrated time management and prioritization skills
• You must have experience managing multiple or competing priorities
• Requires that you have the capacity to maintain confidentiality while working remotely out of your home
• Bachelor's Degree
• Prior claims processing experience
• Overpayment experience
• Financial recovery experience
• Previous experience with Mentor software
• PrePay or Post Pay experience
• CAS, CIS or CISPRO experience
• CRM experience
• Bilingual (Spanish and English; see Language Proficiency Testing information below)

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Company Overview

Company H1B Sponsorship