Medical Claims Rep 2 - Remote FL

Profile

Description

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

The 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

Minimum of 1 year Medical Claims Processing and/or Medical Coding/Billing

Provider Customer Service experience

Proficiency in all Microsoft Office -Basic understanding using Word, Excel, and Outlook

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Associates Degree

Quality background

Medical Coding Certification

Additional Information

Hours: Monday - Friday 8:00 AM to 5:00 PM

Work Style/Location: Remote FL - applicants must reside in the State of FL to be considered

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com