Claims Processing Representative

Humana • Miramar, FL

6d • Onsite

About The Position

Become a part of our caring community and help us put health first The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks. The Claims Processing Representative determines whether to return, deny, or pay claims following organizational policies and procedures. Accurately enters claims information into the company's database and maintain up-to-date records. Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status. Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements. Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed. Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously. Use your skills to make an impact

Requirements

• Medical Claims experience and/or knowledge of medical claims processes
• Knowledge of CPT, ICD-10, and HCPCS coding
• Medical terminology
• Ability to manage multiple or competing priorities, work in a fast-paced environment and adapt quickly to change
• Aptitude for quickly learning and navigating new technology systems and applications
• Ability to think analytically
• Strong focus on accuracy and detail
• Proficiency in all Microsoft Office Programs, including Word, PowerPoint, and Excel

Nice To Haves

• Billing experience
• Coding Certification
• Previous inbound call center or related customer service experience
• Knowledge of HIPAA 837 and 835 electronic claims transactions
• Knowledge of Medicare Risk Adjustment and/or Medicaid processes

Responsibilities

• Reviews and adjudicates complex or specialty claims, submitted either via paper or electronically while performing basic administrative/clerical/operational/customer support/computational tasks.
• Determines whether to return, deny, or pay claims following organizational policies and procedures.
• Accurately enters claims information into the company's database and maintain up-to-date records.
• Communicates effectively with policyholders, healthcare providers, and other stakeholders to gather necessary information and provide updates on claim status.
• Ensures all claims are processed in accordance with company policies, industry regulations, and legal requirements.
• Investigates and resolves discrepancies or issues related to claims, working collaboratively with other departments as needed.
• Provides exceptional service to clients, addressing inquiries and concerns promptly and courteously.

Benefits

• Humana provides 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, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed