[Remote] HCPR Reimbursement Claims Processing 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

High School Diploma or equivalent
1-3 years of experience within the Healthcare and/or insurance industry
Strong computer navigation and Data Entry skills
Ability to perform computations
Repeating, rotating schedule of Monday-Friday and Tuesday-Saturday
Weekday hours: 9:00 AM-5:30 PM EST
Saturday hours: 7:00 AM-3:30 PM EST
Bilingual candidates strongly preferred
Medical or pharmacy benefit claim processing experience is ideal
Customer service telephone experience
Intermediate Microsoft application skills
Previous employment with work at home background
Minimum internet download speed of 25 Mbps and upload speed of 10 Mbps

Responsibilities

Adjudicate pharmacy claims
Process pharmacy claims for payment
Perform varied administrative/operational/customer support assignments
Determine whether to return, deny, or pay claims following organizational policies and procedures
Interpret area/department policy
Complete assignments
Outreach to members or pharmacies in conjunction with claim processing duties
Achieve efficiency, accuracy, and minimal idle time activity

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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