[Remote] Claims Research & Resolution Representative 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

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
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 (i.e., Mentor) to find a resolution to an issue and/or respond to an inquiry
Demonstrated time management and prioritization skills
Ability to manage multiple or competing priorities
Capacity to maintain confidentiality working remotely out of your home
Willingness to attend virtual training (8:00 AM to 4:30 PM Eastern, Monday - Friday for 8-10 weeks) with perfect attendance and no time off
Perfect attendance during initial 180-day appraisal period (classroom training and nesting)
Commitment to remain in the position for 18 months before applying to other Humana opportunities
Ability to work an assigned 8-hour shift between 8:00 AM to 6:00 PM Eastern following training (overtime may be required based on business needs)

Responsibilities

Taking inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues
Recording notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly
Escalation of unresolved and pending customer inquiries
Managing claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues
Working with insurance companies, providers, members, and collection services in the resolution of claims
Handling moderately complex call center, administrative, operational and customer support assignments
Performing semi-routine assignments along with intermediate level math computations
Making decisions focused on interpretation of area or department policy and methods for completing assignments, with some opportunity for interpretation/deviation and independent discretion
Working within defined parameters to identify work expectations and quality standards, with latitude over prioritization and timing, under minimal direction

Skills

Key technologies and capabilities for this role

Call CenterCustomer ServiceClaims ProcessingClaims ResearchClaims ResolutionTelephonic SupportFinancial RecoveryInbound CallsPolicy Interpretation

Questions & Answers

Common questions about this position

Is this position remote?

Yes, this is an opportunity to work remotely out of your home.

What is the required work schedule during training?

Virtual training starts on day one and runs for the first 8 to 10 weeks with a schedule of 8:00 AM to 4:30 PM Eastern, Monday - Friday, with no time off allowed.

What are the required qualifications for this role?

Required qualifications include 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, strong technical skills, self-reliance, time management, and ability to manage multiple priorities while maintaining confidentiality.

What is the company culture like at Humana?

Humana has a great culture focused on associate engagement and well-being, with excellent professional development and continued education opportunities.

What makes a strong candidate for this position?

Strong candidates will have call center experience, healthcare background, technical proficiency with multiple systems, self-reliance, and excellent time management skills to handle inbound calls and resolve complex claims issues independently.

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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