Description

At Humana, we look for people who have a commitment to support the best health of our members and communities. We do this by delivering personalized, simplified, whole-person healthcare experiences. We value diversity and inclusion, as well as people who will foster a good workplace culture. If you have a passion to work for a Fortune 50 Company with great benefits, we have a role for you.

Humana is currently seeking a Claims Research & Resolution Representative 2 to work in the Inbound Call Center. This role manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization.

Responsibilities

What you can expect in a Claims Research & Resolution Representative 2 role at Humana:

• This is a Customer Service Inbound Call Center role driven by quality, production metrics, and compliance requirements.
• Works with medical providers in the settlement of claims.
• Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
• Provide exceptional customer service and attention to details while listening on calls.
• Managing multiple or competing priorities, including use of multiple computer applications simultaneously.
• Effectively communicating with customers verbally and listening to their needs.
• Accurately and completely document provider needs, inquiries, or questions during calls within multiple systems.

Required Qualifications

• Minimum 1 year of call center or related customer service experience.
• Proficient in Microsoft Office to include Word, Outlook, Excel, and One Note
• Must be passionate about contributing to an organization focused on continuously improving the consumer experience.
• Capacity to maintain confidentiality.

Preferred Qualifications

• Associates Degree
• Prior claims processing experience
• PrePay or Post Pay experience
• Overpayment experience
• Bilingual (Spanish)

Required Work Schedule:

• Must be able to work any shift between the hours of 8:00 am – 6:00 pm EST, Monday – Friday.
• Training: Humana offers virtual training for the first 8 -10 weeks following start. 8:00 EST – 4:30 EST. Attendance during training is vital for your success. No time off is allowed during training.
• Following training, must be available to work any 8-hour shift between the hours 8:00 am - 6:00 pm EST, Monday – Friday (subject to change based on business needs).
• The initial 120 days of employment as an Inbound Contact Representative 2 constitute an appraisal period. This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods.
• This position requires learning many systems, policies, and tools, and it takes time 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.

Additional Information

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

If you are selected to move forward, you will receive a text correspondence/email inviting you to participate in a screening. It is recommended to open this screening on a computer to better articulate your answers. Your assessment will be reviewed, and you will subsequently be informed if you will be moving forward to interview.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.

Humana is more than an equal opportunity employer, Humana’s dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful. #LI-REMOTE #LI-JM2

Scheduled Weekly Hours

40

Pay Range

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$34,500 - $47,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.