Claims Processor - Seasonal

Profile

Description

Work at Home in: Louisville, KY or Irving/Dallas, TX

The UM Administration Coordinator 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The UM Administration Coordinator 2 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focused 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

1-3 years of experience within the Healthcare and/or Insurance industry

Excellent verbal and written communication skills

Analytical thinking skills and comfortable working independently and with minimal supervision

Working knowledge of MS Office including Word, Excel, and Outlook in a Windows based environment and an ability to quickly learn new systems

Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M

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

Preferred Qualifications

Knowledge and experience with claims management systems

Proficient utilizing electronic medical record and documentation programs

Proficient and/or experience with medical terminology and/or ICD-10 codes

Bachelor's Degree in Business, Finance or a related field

Prior member service or customer service telephone experience desired

Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization

Additional Information

Work at Home in: Louisville, KY or Irving/Dallas, TX

Role requires a repeating, rotating schedule of Monday-Friday and Tuesday-Saturday with weekday hours being 9:00 AM-5:30 PM EST and Saturday being 7:00 AM-3:30 PM EST.

Role requires working on a computer transcribing data from scanned images into a claims processing system

Role requires toggling and working in multiple software systems

Role requires some outbound calls, thus a quiet environment is needed

Role requires extensive virtual three week training with no time off without exception review

At times, role requires mandatory overtime starting as early as 7 AM EST on weekdays.

Additional Information

Working in the state of Arizona must comply with the Tobacco Free Hiring Policy and upon offer will be subjected to nicotine testing as part of a 10-panel drug test

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a Modern Hire assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed and you will subsequently be informed if you will be moving forward to next round.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

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