Job type full-time
Full job description
The claims research & resolution professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organizationApproves all claim settlements both for and against the organizationThe claims research & resolution professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Where you come in
The south carolina medicaid market is looking for a dynamic, self-motivated, team player to join our team as our claims research and resolution professional 2! the south carolina medicaid claims research and resolution professional 2 performs advanced operational and customer support that requires independent initiative and judgmentThis role will work with both providers and members solving complex claims issues and help champion provider disputesThis exciting role will help influence and drive initiatives across the market and will be pivotal to the success of the market.
The claims research and resolution professional 2 manages the market’s claims operations and investigationThis role will serve as a conduit of communication between provider, members, and the planThe role frequently requires interpretation and independent thinking and works within broad guidelines with little oversight.
What humana offers
We are fortunate to offer a remote opportunity for this positionOur fortune 100 company values associate engagement & your well-beingWe also provide excellent professional development & continued education.
Required qualifications – what it takes to succeed
Minimum of a bachelor’s degree
Minimum of 5 years prior experience with claims research and investigations
Prior experience working within a healthcare organization
Proficiency in microsoft office applications word, excel and outlook
Must be able to work overtime when required
If progressed to offer, you will be required to:
Provide proof of full vaccination or commit to weekly testing, following all cdc protocols, or provide documentation for a medical or religious exemption consideration.
Proficient utilizing electronic medical record and documentation programs.
Wah requirements: must have the ability to provide a high speed dsl or cable modem for a home officeAssociates 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.
As part of our hiring process, we will be using an exciting interviewing technology provided by modern hire, a third-party vendorThis technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded voice interview and/or an sms text messaging interviewIf participating in a pre-recorded interview, you will respond to a set of interview questions via your phoneYou should anticipate this interview to take approximately 10-15 minutes.
If participating in a sms text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions providedExpect this type of interview to last anywhere from 5-10 minutesYour recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled weekly hours
Posted 3 days ago