Claims Review Representative - Remote

Overview

Become a part of our caring community and help us put health first. A Claims Review Representative 2 is responsible for analysis of overpaid claims and makes appropriate determinations based on strong knowledge of claims procedures, contract provisions, and CMS guidelines.

In Short

• Analyze overpaid claims and make determinations.
• Maintain performance standards and meet SLAs.
• Perform root cause analysis to mitigate claim overpayments.
• Collaborate with departments like Claims, Finance, and Provider Services.
• Work within the Financial Recovery Life Cycle.
• Utilize Microsoft Office applications.
• Work remotely with a flexible schedule.
• Participate in virtual training sessions.
• Occasional travel to Humana's offices for meetings.
• Receive a bi-weekly internet payment if located in certain states.

Requirements

• 2+ years of medical claims knowledge or claims processing experience.
• Proficiency in Microsoft Office applications.
• Ability to work in CST or EST time zones.
• Experience with financial recovery processes preferred.
• Strong analytical and problem-solving skills.
• Ability to learn new systems quickly.
• Strong written communication skills.
• Experience in a production environment.
• Ability to manage and prioritize tasks effectively.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability coverage.
• Life insurance and other opportunities.