Claims Research & Resolution Representative 2

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first! The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. This position involves moderately complex call center, administrative, operational, and customer support assignments. The workload typically includes semi-routine assignments along with intermediate-level math computations. This is an opportunity to work remotely and utilize your research, resolution, and customer service skills to join a Fortune 100 company with a great culture and outstanding benefits. Humana values associate engagement and well-being, and we provide excellent professional development and continued education.

Training and Start Date

• Start Date: Monday, August 11th
• Training Duration: 8-10 weeks
• Training Schedule: 8:00 AM to 4:30 PM Eastern, Monday - Friday
• Attendance: Perfect attendance is required during training. No PTO will be granted during this period.
• Appraisal Period: The initial 120 days of employment constitute an appraisal period essential for learning and development, requiring perfect attendance during both classroom training and nesting periods.
• Commitment: You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.

Responsibilities

• Take inbound calls to address customer needs, which may include complex financial recovery, answering questions, and resolving issues.
• Record detailed notes of inquiries, comments, complaints, transactions, or interactions and take appropriate action.
• Escalate unresolved and pending customer inquiries.
• Make decisions focused on the interpretation of area or department policy and methods for completing assignments.
• Interpret and deviate from standard policies and practices with some latitude for independent discretion.
• Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing, under minimal direction.

Requirements

• 1 or more years of Call Center or Telephonic customer service experience (within the past 5 years).
• Previous health care-related experience or related education.
• Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills.
• Strong technical skills with the ability to work across multiple software systems.
• Self-reliance with the ability 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.

Work Hours

• Following training, you must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern Standard Time.
• Overtime may be required.

How We Value You!

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parental Leave.
• Numerous well-being programs.

Company Information

Humana is a Fortune 100 company with a great culture and outstanding benefits, committed to putting health first. We value associate engagement and well-being and provide excellent professional development and continued education.