Claims Review Representative 4

Claims Review Representative 4

12 Aug 2024
Alabama, Birmingham, 35201 Birmingham USA

Claims Review Representative 4

Vacancy expired!

DescriptionThe Claims Review Representative 4 Financial Recovery Overpayment Team makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation.How we Value YouBenefits starting day 1 of employmentCompetitive 401k matchGenerous Paid Time Off accrualTuition ReimbursementParent LeaveGo365 perks for well-beingResponsibilitiesThe Claims Review Representative 4, Financial Recovery Overpayment Department, partners with various teams on pre and post-pay claims to identify overpayments. Decisions are regarding the daily priorities for the Financial Recovery team, including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others. Works within broad guidelines with little oversight.Performs Root Cause analysis and pursues opportunities to mitigate claim overpayments

Works with other departments such as Claims, Finance, Provider Services, and Provider Configuration and Load

Serves as a subject matter expert (SME) for Financial Recovery

Leads Financial Recovery efforts Pre-pay and Post Pay

Required Qualifications3 or more years of Medical claims knowledge and/or claims processing experience within the healthcare industry.

Previous experience with coordinating and leading projects and tasks

Proven ability to utilize analytical thinking in determining root cause.

Experience in handling multiple competing priorities

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred QualificationsFinancial Recovery Experience

Provider contract interpretation knowledge

Proficiency in Microsoft Office applications including Word, Excel and Outlook

Knowledge of Microsoft Access and/or other relational databases

Additional InformationMust be able to accommodate the Eastern Time Zone. 8am-5pm EST, Overtime as needed based on business needs

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This 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 interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You 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 provided. Expect this type of interview to last anywhere from 5-10 minutes. Your 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.Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.Work-At-Home RequirementsWAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates 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

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.Scheduled Weekly Hours40

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