As a Consumer Service Operations Professional 1 at Humana Inc., you will perform installation, implementation, client support, services, administration, customer service, enrollment, eligibility, claims processing, and call center operations. You will investigate and settle claims and customer service issues, reporting to a Manager of Business Intelligence and becoming part of our caring community that puts health first.
What You'll Do
- Research customer inquiries to resolve claims issues, providing updates to business partners and leadership.
- Document and track issues relating to financial, system, and beneficiary data.
- Coordinate and present research findings to internal and external customers.
- Make recommendations based on root cause analysis related to policies, procedures, claims, provider, and beneficiary data.
What We're Looking For
- U.S. citizenship for this position (Department of Defense Contract requirement).
- Ability to successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
- Not currently living in Puerto Rico (HGB not authorized to do work in Puerto Rico per government contract).
- 3 years of experience in a managed care environment.
- 3 years of claims experience processing/adjudicating professional, inpatient, and outpatient claims.
- Experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement.
- 2 years of customer service experience.
- Familiarity with reimbursement terminology (e.g., DME, DRG, HCPCS, CPT coding, Revenue codes).
Team & Environment
You will report to a Manager of Business Intelligence.
Benefits & Compensation
- Compensation: $45,400 - $61,300 per year.
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
- Short-term and long-term disability insurance.
- Life insurance.
Work Mode
This is a remote position.
It is the policy of Humana not to 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.
