Pharmacy Claims Representative 2

Job Summary

Employment Type: Full time

Become a part of our caring community and help us put health first. The Pharmacy Claims Representative 2 adjudicates and processes pharmacy claims for payment. This role performs varied activities and moderately complex administrative/operational/customer support assignments, including computations. Typically works on semi-routine assignments.

Responsibilities

The Pharmacy Claims Representative 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically focused on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Use your skills to make an impact.

Required Qualifications

• Less than 2 years of technical experience
• Less than 5 years of data analysis & problem solving skills
• Comprehensive knowledge of all Microsoft Office applications, including Access, Word, Excel and PowerPoint
• Strong verbal and written communication skills, including the ability to tailor communication to audience
• Strong organizational and time management skills
• Ability to handle multiple tasks, meet deadlines, and follow-up timely
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• High School Diploma or GED
• Previous experience with pharmacy benefits management
• Claims experience
• Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)
• Pharmacy Tech experience

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

• Scheduled Weekly Hours: 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

• $40,000 - $52,300 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings.