Location
San Juan, PR, United States
Posted on
Aug 16, 2022
Profile
Description
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.
Responsibilities
Where you Come In
The Bilingual Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the settlement of claims. 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.
Key Responsibilities
Address incoming telephone, digital, and/or written inquiries from providers
Escalate complex and unable to resolve inquiries through proper channels
This position reports to the Claims Research and Resolution Supervisor, CCM Service Experience and work closely with all teams in the Customer Service Shared Services department, while potentially collaborating across CCM. This position represents the company by addressing incoming telephone, digital, or written inquiries.
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications:
Fully Bilingual English/Spanish . Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish.
Minimum 1 year of call center or related customer service experience
Schedule: Must be able to work any shift between 8:00AM - 6:00 PM EST (Monday - Friday), Overtime as needed based on business needs
Humana offers 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.
Must be passionate about contributing to an organization focused on continuously improving the consumer experience.
Capacity to maintain confidentiality
Strong attention to detail
Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously
Effective verbal and listening communication skills
Preferred Qualifications
Associates Degree
Prior claims processing experience
MTV (MetaVance)
PrePay or Post Pay experience
Overpayment experience
Additional Information - How we Value You
Benefits starting day 1 of employment
Competitive 401(k) match
Generous Paid Time Off accrual
Tuition Reimbursement
Parental Leave
Go365 perks for well-being
Work-At-Home Requirements
Must have the ability to provide a high speed DSL or cable modem for a home office (satellite and wireless internet service is NOT allowed for this role). Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
A dedicated space conducive to learning and keeping protected health information (PHI / HIPAA) of our members confidential. Your designated work location must be located away from other household distractions, including but not limited to ensuring that alternate caregiving arrangements are made for dependents or other members in the household.
Please be advised, Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Candidates must be tested in ALL languages listed on the description.
Covid-19 Vaccine Policy
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.
Additional Information
As part of our hiring process for this opportunity, we will be using an exciting 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. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. #LI-REMOTE
Scheduled Weekly Hours
40
Company info
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