[Remote] HCPR Reimbursement Claims Processing Representative at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

High School Diploma or equivalent
1-3 years of experience within the Healthcare and/or insurance industry
Ability to work a repeating, rotating schedule of Monday-Friday and Tuesday-Saturday (weekday hours 9:00 AM-5:30 PM EST; Saturday 7:00 AM-3:30 PM EST)
Strong computer navigation and Data Entry skills
Passionate about contributing to an organization focused on continuously improving consumer experiences
Meet work at home internet requirements (minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection suggested)
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

Adjudicate pharmacy claims and process pharmacy claims for payment
Perform varied activities and moderately complex administrative/operational/customer support assignments
Perform computations on semi-routine assignments
Determine whether to return, deny, or pay claims following organizational policies and procedures
Make decisions focused on interpretation of area/department policy and methods for completing assignments
Conduct outreach to member or pharmacy in conjunction with Claim Processing duties
Meet production-based expectations gauged on efficiency, accuracy, and minimal idle time activity

Skills

Key technologies and capabilities for this role

Data EntryClaims ProcessingMicrosoft OfficeCustomer ServiceHealthcare ClaimsPharmacy Benefits

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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