Call Center and Claims Representative iCare - Remote US

Profile

Description

iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees and providers by providing a resource by phone to answer inquiries related to benefits, eligibility, claims, and perform other duties as assigned.

Responsibilities

The Call Center and Claims Representative works in a call center setting and provides program, benefit, eligibility, and claims information and describes iCare services to existing, potential and new members via telephone and in writing. This role will also provide responses to provider claim inquiries within the designated timeframes, including claims status, denials, reconsiderations, and explanation of payments.

Essential Duties and Responsibilities


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.
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.
Documents member information, including demographics and contacts made with customers within the Trizetto Call Tracking system.
Consistently meets individual performance and quality goals.
Adheres to Company policy guidelines.
Actively participates in department / company meetings.
Volunteers to participate in i Care community programs /events based on management approval.
Manages complaints / grievances / appeals and route appropriately for research and resolution.


Required Qualifications


1 year of demonstrated customer service experience in a call center setting.
1 year of experience in health insurance.
Experience in 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.
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.
Effective verbal and written communication skills.
Must have the ability to provide a high-speed DSL or cable modem for a home office.
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.


Preferred Qualifications


Previous experience in Medicaid and/or Medicare, customer service and/or claims processing.
Bi-lingual in Spanish
Previous experience working in a managed health care setting.


Additional Information


Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
Typical Work Days/Hours: Monday through Friday; 8:30am - 5:00 pm (CST)


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.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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