Welcome to Jobsnearme.fresherhiring.in We provide job seekers with information gathered from various publicly available job posting websites, including but not limited to Google, Indeed, LinkedIn, and other well-known job platforms. Our mission is to help individuals find employment opportunities by offering up-to-date job listings and career-related resources. We do not charge any fees for accessing or using our website, and all job information is provided free of charge.
Jobsnearme.fresherhiring.in does not directly offer, manage, or engage in the hiring process for any of the job listings featured on our website. All listings are sourced from third-party job posting platforms such as Indeed, LinkedIn, and other recognized job websites.
By using our website, you acknowledge and accept the above terms and conditions. Thank you for visiting Jobsnearme.fresherhiring.in, and we wish you success in your job search.
[Hiring] Claims Research & Resolution Representative @Humana
Other Jobs To Apply
No other job posts for this day.
Role Description
Become a part of our caring community and help us put health first. The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. You will perform moderately complex call center, administrative, operational and customer support assignments. Workload is typically semi-routine assignments along with intermediate level math computations. This is an opportunity to work remotely and use your research, resolution and customer service skills to join a Fortune 100 company with a great culture and outstanding benefits.
As a Claims Research & Resolution Representative 2, you will work with insurance companies, providers, members, and collection services in the resolution of claims. Your responsibilities include:
Taking inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues.
Potentially making outbound calls regarding case follow-up.
Recording notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly.
Escalating unresolved and pending customer inquiries.
Making decisions focused on interpretation of area or department policy and methods for completing assignments.
Working within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing.
Cross-training in all functions within the department.
Qualifications
1 or more years of Call Center or Telephonic customer service experience (within the past 5 years).
Previous healthcare related experience or education.
Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills.
Strong technical skills with the ability to work across multiple software systems.
Self-reliant, with the ability to resolve issues independently under minimum supervision.
Ability to use internal system resources (i.e., Mentor) to find a resolution to an issue and/or respond to an inquiry.
Demonstrated time management and prioritization skills.
Experience managing multiple or competing priorities.
Capacity to maintain confidentiality while working remotely out of your home.
Requirements
Virtual training starts on day one of employment and will run up to 8 weeks with a schedule of 8:00 AM to 4:30 PM Eastern Time, Monday - Friday.
Attendance is vital for your success; no time off will be allowed during training.
The initial 180 days of employment constitute an appraisal period requiring perfect attendance during both the classroom training and nesting periods.
Willingness to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.
Following training, you must be able to work an assigned 8-hour shift between the hours of 8:00 AM to 6:00 PM Eastern Time.
Overtime may be offered, based on business needs.
Preferred Qualifications
Bachelor's Degree.
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.
Bilingual (Spanish and English).
Benefits
Competitive benefits that support whole-person well-being.
Medical, dental and vision benefits.
401(k) retirement savings plan.
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.
Additional Information
Work at Home Guidance: Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.
Associates who live and work from Home in specific states will be provided a bi-weekly payment for their internet expense.
Humana will provide 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 Testing: Any associate who speaks with a member in a language other than English must take a language proficiency assessment.
Interview Process: We will be using technology called HireVue to enhance our hiring and decision-making ability.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
