Claims Processing Representative

Humana • Miramar, OH

8d • Onsite

About The Position

The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. This is in office position requires you to be on site at our Miramar, FL branch location. The Claims Processing Representative 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.

Requirements

• Less than 3 years of technical experience
• Proficiency in all Microsoft Office: Word, PowerPoint, Excel, and Access
• Health plan claims processing experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Bachelor's Degree
• Quality background
• Prior Billing and Enrollment experience
• CPU (CMS Processing Unit) case knowledge

Responsibilities

• Reviews and adjudicates complex or specialty claims, submitted either via paper or electronically.
• Performs varied activities and moderately complex administrative/operational/customer support assignments.
• Performs computations.
• Determines whether to return, deny, or pay claims following organizational policies and procedures.
• Works within defined parameters to identify work expectations and quality standards.
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level