[Remote] Claims Processing Representative 1 at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Entry Level & New GradExperience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries

Requirements

  • 1-2 years of experience working in an administrative or data entry role
  • Experience working with Microsoft Word
  • Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change
  • Aptitude for quickly learning and navigating new technology systems and applications
  • Ability to think analytically
  • Strong focus on accuracy and detail
  • Preferred Qualifications
  • Previous inbound call center or related customer service experience
  • Previous Medical Claims experience and/or knowledge of claims processes
  • Knowledge of HIPAA 837 and 835 electronic claims transactions
  • Knowledge of Medicare Risk Adjustment and/or Medicaid processes

Responsibilities

  • Reviews and adjudicates complex or specialty claims, submitted via paper
  • Performs basic administrative/clerical/operational/customer support/computational tasks
  • Works on routine and patterned assignments
  • Determines whether to return, deny, or pay claims following organizational policies and procedures
  • Makes decisions limited to defined parameters around work expectations, quality standards, priorities and timing
  • Works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation

Skills

Key technologies and capabilities for this role

Microsoft WordClaims ProcessingData EntryHIPAACustomer ServiceAnalytical Thinking

Questions & Answers

Common questions about this position

What is the salary range for the Claims Processing Representative 1 position?

The pay range is $39,000 - $49,400 per year for full-time employment, which may vary based on geographic location, skills, knowledge, experience, education, and certifications.

Is this a remote position, and what are the work-from-home requirements?

This is a remote/work at home role that can be based anywhere in the United States, requiring a dedicated space without interruptions to protect PHI/HIPAA information, minimum internet speeds of 25 Mbps download and 10 Mbps upload, and occasional travel for training or meetings may be needed.

What are the required qualifications for this role?

Required qualifications include 1-2 years of experience in an administrative or data entry role, experience with Microsoft Word, ability to manage multiple priorities in a fast-paced environment, aptitude for learning new technology, analytical thinking, and strong focus on accuracy and detail.

What preferred qualifications would make me a stronger candidate?

Preferred qualifications include previous inbound call center or customer service experience, medical claims experience, knowledge of claims processes, HIPAA 837 and 835 transactions, and Medicare Risk Adjustment or Medicaid processes.

What internet and equipment requirements are there for working from home?

A minimum download speed of 25 Mbps and upload speed of 10 Mbps is required, with wired cable or DSL suggested; Humana provides telephone equipment, and employees in California, Illinois, Montana, or South Dakota receive bi-weekly internet expense payments.

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.

Land your dream remote job 3x faster with AI