BILINGUAL Claims Research & Resolution Representative 2
Company: Humana
Location: Santa Fe
Posted on: April 28, 2024
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Job Description:
Become a part of our caring community and help us put health
first
The Bilingual Claims Research & Resolution Representative 2 manages
claims operations that involve customer contact, investigation, and
resolution of claims. The Bilingual Claims Research & Resolution
Representative 2 performs varied activities and moderately complex
administrative / operational / customer support assignments.
Performs computations. Typically works on semi-routine
assignments.
The Bilingual Claims Research & Resolution Representative 2 works
with insurance companies, providers, members, and collection
services in the resolution of claims.
This claims inbound call center is comprised of a group of calls /
claims / provider associates researching the resolution to a
pending call.
Decisions are typically focused 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.
Use your skills to make an impact
Required Qualifications
1 or more years of Call Center or Telephonic customer service
experience (in the past 5 years)
Bilingual (Spanish / English) (see Language Proficiency Testing
below)
Self-reliant; ability to resolve issues independently with minimum
supervision
Ability to use internal system resources (i.e., Mentor) to find a
resolution to an issue/respond to an inquiry
Demonstrated time management and prioritization skills
Ability to manage multiple or competing priorities
Strong technical skills with the ability to work across multiple
software systems
Capacity to maintain confidentiality working remotely out of your
home
Basic Microsoft Office (Word, Excel, PowerPoint, and Outlook)
skills
Required Work Schedule
Training
Virtual training starts on day one of employment and will run for
the first 8 to 10 weeks with a schedule of 8:00 AM to 4:30 PM
Eastern, Monday - Friday.
Attendance is vital for your success; no time off will be allowed
during training.
The initial 120 days of employment as a Claims Research &
Resolution Representative 2 constitute an appraisal period.--- This
Appraisal Period is essential to your learning and development,
which is why we ask for perfect attendance during both the
classroom training and nesting periods.
This position requires learning many systems, policies, and tools,
and it takes time to become proficient in the role. You must be
willing to remain in this position for a period of eighteen (18)
months before applying to other Humana opportunities.
Work Hours
Following training, must be able to work a schedule of 8:00 AM to
4:30 PM Eastern.
Overtime may be offered, based on business needs.
Preferred Qualifications
Previous health care related experience or education
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
Additional Information
****PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION
(PDF OR WORD FORMAT) **** ---
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work
effectively, the self-provided internet service of Home or Hybrid
Home/Office associates 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.
Associates 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 associates 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.
Language Proficiency Testing
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.
Interview Process
As part of our hiring process for this opportunity, we will be
using technology called HireVue / Modern Hire to enhance our hiring
and decision-making ability. HireVue / 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.---
Text Prescreen: Shortly after submitting your application, you may
receive both a text message and email requesting you to complete 10
to 15 prescreen questions with either yes or no answers. The text
message may arrive prior to the email. If you prefer to answer via
computer or tablet, wait for the email.
Video Prescreen: If you are successful with the text prescreen, you
will receive another communication to record a Video Prescreen.
This is an online video activity using your phone, tablet, or
computer; however, most candidates prefer using a computer or
tablet.
Interviews: Some candidates will be invited to interview. If so,
the recruiter will reach out to schedule.
Offers: Finalists from the interview will be contacted by a
recruiter to discuss an offer for the job
Note: Depending on the number of openings, the number of candidates
who apply, and the schedules of interviewers and recruiters, this
process may take several weeks or less; however, know that we are
working hard to proceed as quickly as possible and to keep you
informed.
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
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.
Keywords: Humana, Santa Fe , BILINGUAL Claims Research & Resolution Representative 2, Other , Santa Fe, New Mexico
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