[Remote] Correspondence Representative at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

1+ years of strong technical skills with the ability to work across multiple software systems including Outlook, Teams
2+ years of Customer Service and/or administrative experience
Proficiency with Microsoft office applications (Word, Excel, Outlook)
1+ years of claims experience (Preferred)
1+ years of Medicare and/or Medicaid experience (Preferred)
MHK knowledge (Preferred)
CRM knowledge (Preferred)
CAS experience (Preferred)

Responsibilities

Performs research, analysis, documentation, and interpretation for the provider reimbursement programs
Updates, maintains, and reviews fee scheduling and pricing structures
Ensures contracted rates and reimbursement policies are priced and applied accurately
Makes reimbursement policy and process recommendations and ensures compliance with government regulations
Analyzes provider reimbursement patterns and trends
Makes decisions that are typically focused on methods, tactics and processes for completing administrative tasks/projects
Regularly exercises discretion and judgment in prioritizing requests, interpreting and adapting procedures, processes and techniques
Works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge
Work flexibility to work any 8-hour shift between the hours of 6:00 AM – 6:30 PM Eastern time, Monday - Friday

Skills

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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