[Remote] Pharmacy Claims Representative 2 - Patient Financial Services at Humana

Ohio, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmacy, InsuranceIndustries

Requirements

1 or more years of customer service experience
Previous experience handling both incoming and outgoing phone calls in a professional setting
Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
Intermediate to High level of Windows Based system navigation
Must be able to work a shift between 8am and 8pm EST Monday-Friday

Responsibilities

Adjudicate pharmacy claims and process pharmacy claims for payment
Analyze and answer inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial
Source Patient Assistance program and/or foundation to assist patients in meeting Out Of Pocket responsibility
Take inbound and make outbound calls related to Patient Assistant Program, billing inquiries, and insurance verification
Provide customer service (internal/external)
Documenting case files with complete notes on work
Complete special projects with varied and complex components as needed
Perform varied activities and moderately complex administrative/operational/customer support assignments
Use business knowledge to help analyze data and provide financial support

Skills

Key technologies and capabilities for this role

Customer ServicePharmacy Claims AdjudicationMicrosoft WordMicrosoft ExcelMicrosoft OutlookInbound CallsOutbound CallsInsurance VerificationBilling InquiriesPatient Assistance ProgramsCase Documentation

Questions & Answers

Common questions about this position

What is the salary range for the Pharmacy Claims Representative 2 position?

The pay range is $40,000 - $52,300 per year for full-time employment, which may vary based on geographic location, skills, knowledge, experience, education, and certifications.

Is this a remote position, and are there any travel requirements?

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

What are the required qualifications for this role?

Required qualifications include 1 or more years of customer service experience, previous experience handling both incoming and outgoing phone calls in a professional setting, comprehensive knowledge of Microsoft Products including Word, Excel and Outlook, intermediate to high level of Windows Based system navigation, and ability to work a shift between 8am and 8pm EST Monday-Friday.

What benefits does Humana offer?

Humana offers competitive benefits that support whole-person well-being, designed to encourage associates.

What makes a strong candidate for this Patient Financial Services role?

Strong candidates will have a Bachelor’s Degree in Finance, Accounting or a related field, Pharmacy Technician Certification, and previous Healthcare and/or Mail Order Pharmacy experience, in addition to meeting the required qualifications.

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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