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The 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 impact
 

Required 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 Schedule

Training

• 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 Information

**PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT) **  

Work at Home Guidance

To 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 Testing

Any 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 Fede