[Remote] BILINGUAL Claims Research & Resolution Rep 2 at Humana

Indiana, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bilingual (Spanish/English) with language proficiency testing
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 skills (Word, Excel, Outlook, and Teams)
Strong technical skills with ability to work across multiple software systems
Self-reliance to resolve issues independently with minimum supervision
Ability to use internal system resources (e.g., Mentor) to find resolutions or respond to inquiries
Demonstrated time management and prioritization skills
Ability to manage multiple or competing priorities
Capacity to maintain confidentiality while working remotely from home
Availability for virtual training: 8:00 AM to 4:30 PM Eastern, Monday-Friday for 8-10 weeks with perfect attendance (no time off)
Perfect attendance during initial 180-day appraisal period (classroom training and nesting)
Willingness to remain in position for 18 months before applying to other Humana opportunities
Ability to work assigned 8-hour shift between 8:00 AM to 6:00 PM Eastern following training (overtime may be required based on business needs)

Responsibilities

Manage claims operations involving customer contact, investigation, and resolution of claims or claims-related financial issues
Handle moderately complex call center, administrative, operational, and customer support assignments
Take inbound calls to address customer needs, including complex financial recovery, answering questions, and resolving issues
Record notes with details of inquiries, comments, complaints, transactions, or interactions and take action accordingly
Escalate unresolved and pending customer inquiries
Make decisions focused on interpretation of area or department policy and methods for completing assignments
Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing under minimal direction
Work with insurance companies, providers, members, and collection services in the resolution of claims

Skills

Bilingual Spanish English

Claims Research

Claims Resolution

Customer Service

Call Center

Financial Recovery

Insurance Claims

Provider Relations

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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