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About the Role

The Claims Research & Resolution Representative 2 manages claims operations involving customer contact, investigation, and resolution of claims or claims-related financial issues. This role involves moderately complex call center, administrative, operational, and customer support assignments with semi-routine tasks and intermediate math computations. It offers an opportunity to work remotely for a Fortune 100 company with a strong culture, excellent benefits, professional development, and continued education.

Responsibilities

Take inbound calls to address customer needs, including complex financial recovery, answering questions, and resolving issues.
Potentially make outbound calls regarding case follow-up.
Record detailed notes of inquiries, comments, complaints, transactions, or interactions and take appropriate action.
Escalate unresolved and pending customer inquiries.
Interpret area or department policy and methods for completing assignments.
Work within defined parameters to identify work expectations and quality standards with some latitude over prioritization and timing.
Work with minimal direction.
Cross-train in all functions within the department.

Requirements

One or more years of Call Center or Telephonic customer service experience within the past 5 years.
Previous healthcare-related experience or education.
Basic Microsoft Office (Word, Excel, Outlook, and Teams) skills.
Strong technical skills with the ability to work across multiple software systems.
Self-reliant, with the ability to resolve issues independently under minimum supervision.
Ability to use internal system resources (e.g., Mentor) to find resolutions or respond to inquiries.
Demonstrated time management and prioritization skills.
Experience managing multiple or competing priorities.
Capacity to maintain confidentiality while working remotely.
Must be willing to remain in this position for twelve (12) months before applying to other Humana opportunities.
Home internet service with at least 25 Mbps download and 10 Mbps upload speed.
Work from a dedicated space lacking ongoing interruptions.

Skills

Research
Resolution
Customer service
Call center operations
Claims management
Financial issue resolution
Customer contact
Investigation
Microsoft Office
Technical skills
Interpersonal skills
Time management
Prioritization
Confidentiality

Location

Remote

Work Type

Remote
Full-time

Experience Level

Intermediate level
Minimum supervision

Education Level

Bachelor's Degree (Preferred)

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
Professional development
Continued education

About the Company

Humana Inc. is a leading U.S. healthcare company.
Through its Humana insurance services and CenterWell healthcare services, it aims to make it easier for millions of people to achieve their best health.
The company delivers care and service when people need it, leading to better quality of life for individuals with Medicare and Medicaid, families, individuals, military service personnel, and communities.

Equal Opportunity

Humana does not 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.
Humana takes affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and advance in employment individuals with disability or protected veteran status.
All employment decisions are based only on valid job requirements.
This policy applies 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.