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The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. The position includes 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. Humana values associate engagement and well-being. We also provide excellent professional development and continued education.

The claims inbound call center is comprised of a group of calls / claims / provider associates researching the resolution to a pending call. The Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the resolution of claims. Responsibilities include:

• Taking inbound calls to address customer needs which may include complex financial recovery, answering questions, and resolving issues.
• Recording notes with details of inquiries, comments or complaints, transactions or interactions and taking action accordingly.
• Escalation of unresolved and pending customer inquiries.
• Decisions are typically focused on interpretation of area or department policy and methods for completing assignments.
• Standard policies and practices allow for some opportunity for interpretation / deviation and / or independent discretion. Work is within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization and timing, and works under minimal direction.

Use your skills to make an impact
 

Required 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-reliance with the ability to resolve issues independently with 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
• Ability to manage multiple or competing priorities
• Capacity to maintain confidentiality working remotely out of your home

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 180 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

• 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

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:

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