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Claims Research and Resolution Representative

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Humana

1mo ago

  • Job
    Full-time
    Mid-level (3-4 years)
  • Tampa

AI generated summary

  • You should possess strong analytical skills, attention to detail, and effective communication abilities to resolve claims efficiently and accurately.
  • You will investigate, research, and resolve claims issues, ensuring accurate processing and effective communication with stakeholders to facilitate timely resolutions.

Requirements

  • Required Qualifications
  • Work in Office in Tampa office 5 day 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 Microsoft Word and Excel skills
  • Preferred Qualifications
  • Computer Sciences Corporation (CSC) Experience (CarePlus Platform)
  • Prior medical claims processing experience
  • Member reimbursement experience
  • Intermediate Microsoft Access skills
  • Healthcare customer member call center experience

Responsibilities

  • 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

FAQs

What is the job title for this position?

The job title is Claims Research and Resolution Representative 2.

Where is this position located?

This position is located in the Tampa office.

What are the key responsibilities of the Claims Research and Resolution Representative 2?

The key responsibilities include managing claims operations involving the investigation of claims, performing advanced administrative and operational tasks, and collaborating with ancillary departments, providers, and teammates to settle claims.

What are the required qualifications for this role?

The required qualifications include 1 or more years of medical claims knowledge, 1 or more years of customer service experience, 1 or more years of medical insurance experience, and intermediate proficiency with Microsoft Word and Excel.

Are there any preferred qualifications for applicants?

Yes, preferred qualifications include experience with Computer Sciences Corporation (CSC) on the CarePlus Platform, prior medical claims processing experience, member reimbursement experience, intermediate Microsoft Access skills, and healthcare customer member call center experience.

What are the work hours for this position?

The work hours are Monday to Friday, with a flexible 8-hour shift between the hours of 6:00 am and 5:30 pm.

What is the compensation range for this job?

The compensation range is $34,500 to $47,400 per year, depending on geographic location and individual pay variations based on skills and experience.

What benefits does Humana offer to employees?

Humana offers competitive benefits that include medical, dental and vision coverage, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and opportunities for personal and professional wellness.

Will there be an interview process, and what technologies will be used?

Yes, there will be an interview process using HireVue, which may include a pre-recorded voice interview and/or a SMS text messaging interview.

How can internal applicants ask questions regarding the role?

Internal applicants can send their questions to the Ask A Recruiter persona by visiting go/vivaengage and searching for Ask A Recruiter, providing the requisition number for quicker assistance.

What is Humana’s policy on equal opportunity employment?

Humana is committed to not discriminating against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. They also take affirmative action to employ and advance in employment all persons regardless of these factors.

Science & Healthcare
Industry
1001-5000
Employees
1961
Founded Year

Mission & Purpose

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.