Inbound Claims & Call Center Representative (iCare) - Remote, US

DescriptionWork at iCare, a subsidiary of Humana, and answer your calling to help others by supporting the health, well-being, and healing of our members. iCare is seeking a Call Center and Claims Representative to join our growing team! This position is in a call center setting and meets the needs of iCare members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, and claims.ResponsibilitiesProvides program, benefit, eligibility, claims information and describes i Care services to existing, potential and new members via telephone and in writing.

Provide responses to provider claim inquiries within the designated timeframes including but not limited to claim status including denials and reconsiderations, and explanation of payments.

Provides support, guidance, direction & limited education to providers on member eligibility, authorizations, iCare guidelines and provider portal.

Provides limited authorization information of referrals to providers and members.

Research issues and uses judgment for obtaining relevant information.

Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer (member or provider) requests and questions are handled appropriately and in a timely manner (24 hours in most cases, longer as needed and customer is provided daily status updates until issue addressed).

Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system.

Required Qualifications2-3 years of demonstrated customer service experience in a call center setting with a general understanding of health insurance including claims processing and benefits.

Previous experience in Medicaid, Medicare and/or commercial health insurance.

Experience in managed health care systems and customer service business practices.

Strong interpersonal skills and ability to work effectively with persons with disabilities and a wide variety of ethnic, cultural, and socio-economic backgrounds.

Ability to develop and maintain effective working relationships with providers, members, other agencies and organizations.

Ability to effectively and satisfactorily resolve member and provider issues within specified timelines.

Possess knowledge and experience of appropriate telephone skills.

Experience in the use of a personal computer and software applications, including Microsoft Windows and Microsoft Office Products.

Effectively manages personal work time and possess strong problem-solving skills and the ability to prioritize customer services issues as needed.

Knowledge, skill and ability in implementing customer relations principles and techniques.

Manage complaints / grievances / appeals and route appropriately for research / resolution.

Associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved vendor and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into an iCare facility or work outside of their home.

Preferred QualificationsBi-lingual - English, Spanish preferred.

Previous experience working with Microsoft Windows, including Access.

Additional InformationTypical Work Hours/Days: Monday through Friday; 8:30am - 5:00 pm (CST)

Full Time associates enjoy:$1000 sign-on bonus

Medical, Dental, Vision, and a variety of other supplemental insurances

Generous PTO and paid holidays

401(k) Retirement Savings Plan with Company Match

Tuition Reimbursement

Work/Life Balance

Typical work hours/days - Monday through Friday, 8:30am - 5:00 pm (CST)

Scheduled Weekly Hours40