Humana (501+ Employees, 13% 2 Yr Employee Growth Rate)
The Claims Review Representative 2 , will be part of the Medical Financial Recovery Overpayment Team which consists of making appropriate claim decisions based on strong knowledge of claims procedures, contract provisions, and state and federal legislation.
How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Go365 perks for well-being
The Claims Review Representative 2 partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data.
- Cash Posting
- Performs Root Cause analysis and pursues opportunities to mitigate claim overpayments
- Basic Reporting
- Works with other departments such as Claims, Finance, Provider Services, and Provider Configuration and Load
- Create Financial Recovery Overpayment Letters
- 3 or more years of Medical claims experience (Institutional and professional claims)
- Proficiency in Microsoft Office applications Word and Excel
- Ability to quickly learn new systems
- Ability to manage and prioritize tasks based on business need
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Financial Recovery or Quality Audit experience or working within a similar environment(s)- (Pre and Post Pay)
- Schedule: Monday to Friday from 8 am to 5 pm EST. with flexibility, Overtime as needed based on business needs
- Training: 100% Virtual
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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.
- 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 25×10 (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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana’s secure website.
Scheduled Weekly Hours