Claims Research & Resolution Representative (Special Projects Writer) Apply
Full job description
Become a part of our caring community and help us put health first
The Claims Research & Resolution Representative 4 (Special Projects Writer) 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 4 (Special Projects Writer) assumes ownership and leads advanced and highly specialized administrative / operational / customer support duties that require independent initiative and judgment. The Claims Research & Resolution Representative 4 (Special Projects Writer) works internally with various departments in the settlement of claims comprised of a group of claims associates researching the resolution to an internal issue. Decisions are regarding the daily priorities for an administrative work group coordinating work activities and monitoring progress towards inventory / goals, and often oversees work of others. Works within broad guidelines with little oversight. Works in the department of Special Projects and handles the IPAR Inventory / Process along with reviewing the IPAR for the scope of the project and using internal tools to identify impacted claims.
Use your skills to make an impact
We are only considering candidates who currently reside in either the Eastern or Central Time Zones.
Required Qualifications
- 1+ years of CAS claims experience
- Proficiency in all Microsoft Office programs including Word, PowerPoint, Excel, Access, etc.
- Proven ability to utilize analytical thinking
- Strong attention to detail and accuracy with ability to multi-task and work independently
- Excellent communication both written and verbal in English
- Ability to solve problems and encourage others in collaborative problem solving
Preferred Qualification
- 1+ years of CAS adjustments (rework and adjudication of claims)
- Bachelor's Degree
- Prior claims processing experience
- Experience with Query Doc (EFR) and Audit tool
- Experience or knowledge of CIS and CISPRO contractual reviews
- MTV claims processing experience
- Experience with Contract Load
- Experience with PPirates/SQL
Required Work Schedule
- This department provides coverage from 6:00 AM 5:00 PM, Monday - Friday. This is a full-time, 40 hour per week position with a shift of either 8 hours per day, Monday Friday, OR a flex shift of four 9-hour days and one 4-hour day. Hours are subject to change based on business needs.
- 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 outside of the Claims Research & Resolution department.
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.
Additional Information
**PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT) **
If you would like to do a job shadow, please reach out to Jessica Clark (jclark2@humana.com) or Beth Johnson (ejohnson42@humana.com) to schedule.
Modern Hire Assessment
As part of our hiring process for this opportunity, we will be using 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.
Scheduled Weekly Hours
40Pay 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$40,200 - $55,200 per year
Description of Benefits
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.
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