Claims Review Representative 3

Employment Type: Full-time Location Type: Remote Pay Range: $44,900 - $60,200 per year

Position Overview

Become a part of our caring community and help us put health first. The Claims Review Representative 3 makes appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. This role performs advanced administrative/operational/customer support duties that require independent initiative and judgment, and may apply intermediate mathematical skills.

Where You Come In

• Partner with professional staff on pre-screening review by applying guidance and making appropriate decisions, which may include interpretation of provider information or data.
• Focus decisions on methods, tactics, and processes for completing administrative tasks/projects.
• Regularly exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques.
• Work under limited guidance due to previous experience, breadth and depth of knowledge of administrative processes, and organizational knowledge.

What Humana Offers

• A remote opportunity.
• Fortune 100 Company values associate engagement & well-being.
• Excellent professional development & continued education.
• Use your skills to make an impact.

Required Qualifications – What it takes to Succeed

• Minimum of 1 year of strong and proven experience with processing and adjudicating medical claims.
• Knowledge with CPT, ICD9, and ICD10 terminology/codes.
• Proficiency in Microsoft Office applications including Word, Excel, and Outlook.
• Ability to quickly learn new systems.
• Ability to manage and prioritize tasks based on business need.
• Must reside stateside per Medicaid regulations.

Preferred Qualifications

• CAS and/or CRM experience.
• CIS/CIS Pro experience.
• Finance Knowledge.

Additional Information - How we Value You

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parent Leave.

Work at Home Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
  • Satellite, cellular, and microwave connections can be used only if approved by leadership.
  • Associates who live and work from home in the states of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40