Call Center and Claims Representative

at Humana in Springfield, Illinois, United States

Job Description

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

Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.

The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes Humana/iCare services to existing, potential and new members via telephone and in writing. This role will also provide responses to provider claim inquiries within the designated timeframes, including claims status, denials, reconsiderations, and explanation of payments.

Essential Duties and Responsibilities

+ Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer (member or provider) requests and questions are handled appropriately and in a timely manner.

+ Provides support, guidance, direction & limited education to providers on member eligibility, authorizations, Humana/iCare guidelines and provider portal.

+ Provides limited authorization information of referrals to providers and members.

+ Researches issues and uses judgment for obtaining relevant information.

+ Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system.

+ Consistently meets individual performance and quality goals.

+ Adheres to Company policy guidelines.

+ Actively participates in department/company meetings.

+ Manages complaints/grievances/appeals and route appropriately for research and resolution.

Use your skills to make an impact

Required Qualifications

+ One (1) year of demonstrated customer service experience in a call center setting with knowledge of appropriate telephone etiquette.

+ One (1) year of experience in health insurance.

+ Experienced with Microsoft Office Products.

Preferred Qualifications

+ Previous experience in Medicaid and/or Medicare customer service and/or claims processing.

+ Bi-lingual English/Spanish.

+ Ability to type at least 40 WPM. (Test your typing speed for free online)

+ Experience working in a managed health care setting.

Additional Information

+ Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.

+ Typical Work Days/Hours: must be available Monday through Friday; 8:00am – 5:00 pm (CST)

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

+ Satellite, cellular and microwave connection can be used only if approved by leadership.

+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:

+ Health benefits effective day 1

+ Paid time off, holidays, volunteer time and jury duty pay

+ Recognition pay

+ 401(k) retirement savings plan with employer match

+ Tuition assistance

+ Scholarships for eligible dependents

+ Parental and caregiver leave

+ Employee charity matching program

+ Network Resource Groups (NRGs)

+ Career development opportunities

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

Nationwide Remote – This is a remote nationwide position.

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.$31,900 – $43,900 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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of ?Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.