Become a part of our caring community and help us put health first
 

The Claims Research & Resolution Representative 2 manages claims operations that involve investigation of claims for and against the organization. Perform advanced administrative, operational, and customer support duties that require independent initiative and judgment.

Tampa Office

The Claims Research & Resolution Representative 2

• Works with ancillary departments, providers, mail vendors and teammates in the settlement of claims

• Follows established guidelines/procedures for return checks research, return mail, claim batch load reports, and preloading claims.

Use your skills to make an impact
 

Required Qualifications

• Hybrid -Work in Office in Tampa office 3 days a week /home 2 days a week

• 1 or more years of Medical Claims knowledge

• 1 or more years of the Customer Service experience

• 1 or more years of Medical Insurance experience

• Intermediate proficiency with Excel skills (i.e. Pivot tables)

• Intermediate proficiency with Microsoft Word

Preferred Qualifications

• Computer Sciences Corporation (CSC) Experience (CarePlus Platform)

• Medical claims processing experience

• Member reimbursement experience

• Advanced Microsoft Access SQL

• Healthcare customer member call center experience

• Working knowledge with Microsoft Access

Additional Information
 

Work Days/Hours: Monday – Friday; Must be able to work a flexible 8-hour shift between the hours of 6:00am – 5:30pm. Metwest office in Tampa, FL and work at home- Hybrid

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

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

 

$34,500 - $47,400 per year

 

Description of Benefits

Humana, 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 Us
 

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary