HCPR Reimbursement Claims Processing Representative

San Antonio, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must possess a High School Diploma or equivalent and have 1-3 years of experience in the healthcare and/or insurance industry. Strong computer navigation and data entry skills are essential, along with a passion for improving consumer experiences. The role requires a repeating, rotating schedule of Monday-Friday and Tuesday-Saturday with specific weekday and Saturday hours. Intermediate Microsoft application skills and previous work-at-home experience are preferred.

Responsibilities

The Claims Processing Representative 2 will adjudicate and process pharmacy claims for payment, performing varied administrative and operational tasks. This role involves determining claim adjudication outcomes based on organizational policies and procedures, and may include outreach to members or pharmacies. Success will be measured by efficiency, accuracy, and minimal idle time.

Skills

Claims Processing

Data Entry

Pharmacy Claims

Healthcare Industry

Insurance Industry

Customer Service

Microsoft Office

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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