Claims Quality Audit Representative 3
Humana

Job Info

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Description

The Claims Quality Audit Representative 3 audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. The Claims Quality Audit Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

Decisions 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. Associates in this role will also be given development opportunities including but not limited to, meeting presentations, leading training classes, and many other future development opportunities.

COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF - TUITION ASSISTANCE PROGRAMS - STELLAR WELLNESS/REWARDS PROGRAM

What you need for success! - Required Qualifications

• 1+ years of technical experience

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

What you need to be STAND OUT among the crowd!- Preferred Qualifications

Humana Claims experience

• CAS, CCP2, Medhok, RxNova, Argus

• Minimum 1 year Resolution (G&A) team experience

• Microsoft Word, Excel

• High School Diploma or GED

Schedule: Monday - Friday, 8 hour shift, Flexible Start 6 AM - 9 AM

Additional Information

Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Scheduled Weekly Hours

40

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