CarePlus CLAIMS PROCESSING REPRESENTATIVE 3

DescriptionThe CarePlus Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The CarePlus Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.ResponsibilitiesThis is a remote position for candidates living in the States of FL, GA or TN. Training is Mon-Fri, 8-4:30pm EST. Work hours are flexible 8 hr. shifts.The CarePlus Claims Processing Representative 3 determines whether to return, deny, or pay claims following organizational policies and procedures. 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.Required QualificationsHigh School Diploma or equivalent

1-3 years of institutional claims processing

Knowledge of APC, DRG pricing

Knowledge of Revenue Codes

Strong data entry skills required

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

Preferred QualificationsMedical terminology, CPT-4 and ICD-10 coding & Medicare experience

Experience in medical claims processing

Demonstrated leadership experience (Demonstrated capability with coaching and developing associates formally and informally)

Additional InformationWork-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

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.Scheduled Weekly Hours40