Claims Review Rep 4
The Claims Review Representative 4, Financial Recovery Overpayment Department, partners with various teams on pre and post paid claims to identify overpayments. Screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. 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 and/or is the primary owner of a main Financial Recovery processes. Works within broad guidelines with little oversight.
- Distribution of daily tasks within Financial Recovery
- Team Lead of Financial Recovery
- 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
Consumer Experience Professional
The Consumer Experience Professional 2 contributes to the success of Humana’s business strategy by collaborating with internal and external departments to resolve escalated customer claims issues which promotes beneficiary and provider satisfaction. Aspects of this role include but are not limited to: researching complex claims issues, processing claims corrections, initiating claim recoupments, understanding TRICARE policy, coordinating customer responses, and supporting customer relationship management activities related to Government, beneficiary, and provider feedback and survey findings. Our Department of Defense Contract requires U.S. citizenship for this position.
Inbound Contact Representative I
The Inbound Contacts Representative 1 addresses customer needs which may include complex benefit questions, resolving issues, and educating members. Records details of inquiries, comments or complaints, transactions or interactions and takes action in accordance to it. Escalates unresolved and pending customer grievances. Decisions are limited to defined parameters around work expectations, quality standards, priorities and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.