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.
Responsibilities
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.
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.
- Experience in the use of a personal computer and Microsoft Office Products.
- Experience communicating with other departments effectively through either verbal or written communications.
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.
- 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
Modern Hire
As part of our hiring process for this opportunity, we will be using an 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.