Claims Research & Resolution Representative

Become a part of our caring community and help us put health firstThe Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims. The Claims Research & Resolution Representative 2 performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments.

The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the resolution of claims.

This claims inbound call center is comprised of a group of calls / claims / provider associates researching the resolution to a pending call.

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 impactRequired Qualifications

1 or more years of Call Center or Telephonic customer service experience (in the past 5 years)

Self-reliant; ability to resolve issues independently with minimum supervision

Ability to use internal system resources (i.e., Mentor) to find a resolution to an issue/respond to an inquiry

Demonstrated time management and prioritization skills

Ability to manage multiple or competing priorities

Strong technical skills with the ability to work across multiple software systems

Capacity to maintain confidentiality working remotely out of your home

Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills

Required Work ScheduleTraining

Virtual training starts on day one of employment and will run for the first 8 to 10 weeks with a schedule of 8:00 AM to 4:30 PM Eastern, Monday - Friday.

Attendance is vital for your success; no time off will be allowed during training.

The initial 120 days of employment as a Claims Research & Resolution Representative 2 constitute an appraisal period.  This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods.

This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.

Work Hours

Following training, must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern.

Overtime may be offered, based on business needs.

Preferred Qualifications

Previous health care related experience or education

Bachelor's Degree

Bilingual (Spanish / English) (see Language Proficiency Testing below)

Prior claims processing experience

Overpayment experience

Financial recovery experience

Previous experience with Mentor software

PrePay or Post Pay experience

CAS, CIS or CISPRO experience

CRM experience

Additional InformationPLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT)  Work at Home GuidanceTo ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Associates 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 associates 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.

Language Proficiency TestingAny Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.Interview ProcessAs part of our hiring process for this opportunity, we will be using technology called HireVue / Modern Hire to enhance our hiring and decision-making ability. HireVue / Modern Hire 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. 

Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.

Video Prescreen: If you are successful with the text prescreen, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.

Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule.

Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job

Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.

Scheduled Weekly Hours40Pay RangeThe 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.$34,500 - $47,400 per yearDescription of BenefitsHumana, 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 plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.