Claims Review Representative 3
Humana
Louisville, Kentucky
claims review
representative
claims review
representative
administrative
procedures
judgment
cis
sms
legislation
operational
customer support
intermediate
March 28, 2023
Humana
Louisville, Kentucky
TEMPORARY
Description
The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
Responsibilities
Ready to MOVE UP?
The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
What you need for success! Required Qualifications
High School Diploma or equivalent
Experience with reviewing claims in CAS (within the past 5 years)
Experience with CIS/ CIS Pro
Demonstrated experience with processing and adjudicating claims
Ability to quickly learn new systems
Ability to manage and prioritize tasks based on business need
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
What you need to STAND OUT in the crowd! Preferred Qualifications Associate's or Bachelor's Degree
Knowledge with CPT and ICD9 terminology/codes
Proficiency in Microsoft Office applications Word and Excel
Experience with CCP, CGX, and/or EHUB
Experience with MTV
1 or more years of leadership experience (Demonstrated capability with coaching and developing associates formally and/or informally)
Additional Information
There is a possibility of overtime, as needed
Interview Format
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.
This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes.
Scheduled Weekly Hours
40
The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.
Responsibilities
Ready to MOVE UP?
The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
What you need for success! Required Qualifications
High School Diploma or equivalent
Experience with reviewing claims in CAS (within the past 5 years)
Experience with CIS/ CIS Pro
Demonstrated experience with processing and adjudicating claims
Ability to quickly learn new systems
Ability to manage and prioritize tasks based on business need
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
What you need to STAND OUT in the crowd! Preferred Qualifications Associate's or Bachelor's Degree
Knowledge with CPT and ICD9 terminology/codes
Proficiency in Microsoft Office applications Word and Excel
Experience with CCP, CGX, and/or EHUB
Experience with MTV
1 or more years of leadership experience (Demonstrated capability with coaching and developing associates formally and/or informally)
Additional Information
There is a possibility of overtime, as needed
Interview Format
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.
This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes.
Scheduled Weekly Hours
40
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