Humana
Claims Research & Resolution Representative 2
Join to apply for the Claims Research & Resolution Representative 2 role at Humana.
Base pay range:
$40,000.00/yr - $52,300.00/yr
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 a moderately complex call center environment and requires remote work and strong customer service skills.
Responsibilities
Take inbound calls to address customer needs including complex financial recovery, answer questions, and resolve issues.
Record notes with details of inquiries, comments, complaints, transactions, or interactions and take action accordingly.
Escalate unresolved and pending customer inquiries.
Make decisions based on area or department policy and interpret methods for completing assignments.
Work within defined parameters to meet quality standards while maintaining some latitude over prioritization and timing.
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 to find a resolution to an issue and/or respond to an inquiry.
Demonstrated time management and prioritization skills.
Capacity to maintain confidentiality while working remotely from home.
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.
Training & Work Schedule
Virtual training starts on day one of employment and will run for the first 8 to 10 weeks (8:00 AM – 4:30 PM Eastern, Monday – Friday).
Attendance is vital; no time off will be allowed during training.
The initial 180 days constitute an appraisal period; perfect attendance is required.
The position requires learning multiple systems and policies, and an 18‑month period before applying to other Humana opportunities.
Following training, must be able to work an assigned 8‑hour shift between 8:00 AM and 6:00 PM Eastern; overtime may be offered based on business needs.
Occasional travel to Humana's offices for training or meetings may be required.
Work‑From‑Home Guidance
Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended (wireless, wired cable, or DSL connection). Satellite, cellular, and microwave connections may be used only if approved.
Associates in California, Illinois, Montana, or South Dakota will receive a bi‑weekly payment for internet expense.
Humana will provide telephone equipment appropriate for the role.
Work from a dedicated space free of interruptions to protect member PHI / HIPAA information.
Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana is an affirmative action employer and base all employment decisions on valid job requirements.
#J-18808-Ljbffr
Base pay range:
$40,000.00/yr - $52,300.00/yr
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 a moderately complex call center environment and requires remote work and strong customer service skills.
Responsibilities
Take inbound calls to address customer needs including complex financial recovery, answer questions, and resolve issues.
Record notes with details of inquiries, comments, complaints, transactions, or interactions and take action accordingly.
Escalate unresolved and pending customer inquiries.
Make decisions based on area or department policy and interpret methods for completing assignments.
Work within defined parameters to meet quality standards while maintaining some latitude over prioritization and timing.
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 to find a resolution to an issue and/or respond to an inquiry.
Demonstrated time management and prioritization skills.
Capacity to maintain confidentiality while working remotely from home.
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.
Training & Work Schedule
Virtual training starts on day one of employment and will run for the first 8 to 10 weeks (8:00 AM – 4:30 PM Eastern, Monday – Friday).
Attendance is vital; no time off will be allowed during training.
The initial 180 days constitute an appraisal period; perfect attendance is required.
The position requires learning multiple systems and policies, and an 18‑month period before applying to other Humana opportunities.
Following training, must be able to work an assigned 8‑hour shift between 8:00 AM and 6:00 PM Eastern; overtime may be offered based on business needs.
Occasional travel to Humana's offices for training or meetings may be required.
Work‑From‑Home Guidance
Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended (wireless, wired cable, or DSL connection). Satellite, cellular, and microwave connections may be used only if approved.
Associates in California, Illinois, Montana, or South Dakota will receive a bi‑weekly payment for internet expense.
Humana will provide telephone equipment appropriate for the role.
Work from a dedicated space free of interruptions to protect member PHI / HIPAA information.
Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana is an affirmative action employer and base all employment decisions on valid job requirements.
#J-18808-Ljbffr