Company name
Humana Inc.
Location
Lancaster, SC, United States
Employment Type
Full-Time
Posted on
Jul 07, 2022
Profile
Description
The CarePlus Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The CarePlus Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
Responsibilities
This is a remote position for candidates living in the States of FL, GA or TN. Training is Mon-Fri, 8-4:30pm EST. Work hours are flexible 8 hr. shifts.
The CarePlus Claims Processing Representative 3 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
Required Qualifications
High School Diploma or equivalent
1-3 years of institutional claims processing
Knowledge of APC, DRG pricing
Knowledge of Revenue Codes
Strong data entry skills required
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Medical terminology, CPT-4 and ICD-10 coding & Medicare experience
Experience in medical claims processing
Demonstrated leadership experience (Demonstrated capability with coaching and developing associates formally and informally)
Additional Information
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
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.
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com