[Remote] Claims Research & Resolution Rep

Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading healthcare company committed to putting health first. They are seeking a Claims Research & Resolution Representative 2 to manage claims operations, involving customer contact, investigation, and resolution of claims or claims-related financial issues while providing excellent customer service.

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

Company Overview

Company H1B Sponsorship