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 settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. 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 settlement of claims.

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

• Decisions are typically focus 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)

• Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously

• Capacity to maintain confidentiality

Required Work Schedule: 

Training:

• Virtual training for the first 8 -10 weeks following start from 8:00 AM – 4:30 PM EST, 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 a schedule of 8:00 AM to - 4:30 PM EST.  Overtime may be required, based on business needs.

Preferred Qualifications

• Claims processing experience

• Financial recovery experience

Additional Information

Please be sure to include your resume with your application! 

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. 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!

Work From Home:

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 recommended; 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

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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$34,500 - $47,400 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidi