The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
Responsibilities
Claims Processing Representative 2:
- Determines whether to return, deny, or pay claims following organizational policies and procedures
- 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
Required Qualifications
- Medical Claims Processing and/or Medical Coding/Billing experience
- Provider Customer Service experience
- Proficiency in all Microsoft Office -Basic understanding using Word, Excel, and Outlook
Preferred Qualifications
- Billing and/or Claims background
- Quality background
Additional Information
Hours: Flex Start Time: 6:00 a.m. to 9:00 a.m. EST Monday – Friday with ability to support business as needed for overtime.
Additional Information
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.
Work at Home / Internet Guidance
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.