Claims Specialist I
Grow TherapySalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates should possess at least 23 years of customer service experience, with prior experience in the healthcare industry or medical field being required. Intermediate skills in Microsoft Word and Excel are necessary, along with experience in a production-driven environment and familiarity with the Claims Administration System (CAS). Applicants must also have experience processing medical claims and knowledge of medical terminology.
Responsibilities
The Grievances & Appeals Representative 3 will conduct comprehensive analytic reviews of clinical documentation to determine the need for grievances, appeals, or further requests, and then deliver final determinations based on trained skillsets and partnerships with clinical and other Humana parties. They will assist members via phone or face-to-face in supporting quality-related goals, investigate and resolve member and practitioner issues, and regularly exercise discretion and judgment in prioritizing requests and adapting procedures. Additionally, the representative will apply intermediate mathematical skills and contribute to improving consumer experiences.
Skills
Customer Service
Healthcare Industry Experience
Medical Field Knowledge
Data Entry
Microsoft Word
Microsoft Excel
Administrative Support
Analytical Review
Problem-Solving
Discretion and Judgment
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.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees