Claims Processing Representative

Description The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Responsibilities The Claims Processing Representative 2 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus 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. COME GROW WITH HUMANA! BENEFITS DAY ONE – STELLAR 401K MATCH – PAID TIME OFF – TUITION ASSISTANCE PROGRAMS – STELLAR WELLNESS/REWARDS PROGRAM What you need for success! - Required Qualifications Must be passionate about contributing to an organization focused on continuously improving consumer experiences Must have 2 years of customer service experience Proficiency in Microsoft Word, PowerPoint and Excel as well as comfortable working within multiple programs and systems daily Analytical thinking skills and comfortable working independently and with minimal supervision Excellent verbal and written communication skills The ability to work professionally and within designated time frames Training Schedule (Monday-Friday, 8 am - 4:30 pm). After training, the schedule will be determined between associate and leader. Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Proficiency in all Microsoft Office: Word, PowerPoint, Excel, and Access CAS Claims processing experience Bachelor's Degree 1 years of experience working within a similar environment 1 years of experience within the healthcare and/or Insurance industries Proficient in Microsoft Access Additional Information Will work at the following location: 101 E. Main St, Louisville, KY 40202 This position offers approximately 6 weeks of traditional in-office training. Employees will remain in the office 90 after training, then will have the option to work from home. Please note that training is a critical stage of associate development. Any time off or scheduled obligations during the training period will need to be reviewed as part of the selection process. Work-At-Home Requirements WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Covid-19 Vaccine Requirement We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve. If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work. Scheduled Weekly Hours 40