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About the Role

As a Correspondence Representative 2, you will work in a back-office, non-phone, production-based environment reviewing and researching provider correspondence and disputes. You will identify the root cause of issues by examining case details, claims information, documentation, and established processes. Your role involves researching provider concerns, determining resolution steps, documenting case activity, and generating system-based correspondence. We seek individuals who can balance productivity with accuracy, quality, and effective case resolution.

Responsibilities

Research and resolve provider correspondence and disputes by reviewing claims, case documentation, and available system information.
Perform detailed research and root-cause analysis while following established processes and documenting case activity.
Generate and send required system-based correspondence.
Route requests to internal departments when additional information or review is needed.
Manage assigned inventory while maintaining productivity, accuracy, quality, and required turnaround times.
Opportunities to cross-train.

Requirements

1 or more years of Healthcare claims experience.
2 or more years of Customer Service and/or administrative experience (in past 5 years).
Proficiency with Microsoft Outlook (email communication).
1 or more year of technical experience (multiple system platforms and split screens simultaneously).
1 or more years of Medicare and/or Medicaid experience.
Familiarity with MHK knowledge.
CAS experience.
Familiarity with CRM knowledge.
Experience with provider reimbursement policy analysis and documentation.
Knowledge of regulatory requirements and compliance standards for health insurance.
Microsoft Word (document creation) and Excel (formulas).
Must be on time, in a quiet environment, dressed appropriately, with your camera ON during training and for other meetings required by leadership.
Flexibility to work any 8-hour shift between the hours of 6:00 AM – 6:30 PM EST time, Monday - Friday.
May require some weekends and overtime, based on needs.
Perfect attendance is expected during classroom training and the nesting period (First 120 Days).
No time off is permitted during the first six (6) weeks due to the intensity and sequencing of required training.
Self-provided internet service must meet minimum criteria: 25 Mbps download and 10 Mbps upload.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Occasional travel to Humana's offices for training or meetings may be required.

Skills

Microsoft Outlook
Microsoft Word
Microsoft Excel

Location

Remote
Home/Office

Work Type

Full-time
Remote

Experience Level

1+ years of Healthcare claims experience
2+ years of Customer Service and/or administrative experience
1+ year of technical experience

Salary/Compensations

$40,000 - $52,300 per year

Benefits

Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
Short-term disability
Long-term disability
Life insurance

About the Company

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company.
Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large.
Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity

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 protected veteran status.
It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.