COMPLETE Claims Research & Resolution Lead - Work at Home - Oklahoma

Description

Humana Healthy Horizons in Oklahoma is seeking a Claims Research & Resolution Lead who manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Claims Research & Resolution Lead will also manage a group of associates.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

Responsibilities

The Claims Research & Resolution Lead:

• Works with insurance companies, providers, members, and collection services in the settlement of claims
• Comprised of a group of calls/claims/provider associates researching the resolution
• Advises executives to develop functional strategies (often segment specific) on matters of significance
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision
• Uses independent judgment requiring analysis of variable factors and determining the best course of action

               

Required Qualifications

• Must reside in Oklahoma

• Bachelor's degree
• 8 or more years of technical experience leading a medical/provider/health plan claims operation
• 2 or more years of project leadership experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree

Additional Information

About Humana

Your growth is what drives Humana forward. 

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
• This is a place where our nurses influence the C-suite
• Where software engineers change lives
• Where every associate can build a professional path where they learn and thrive
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security
• Because finding new ways to put health first—for our members and patients and  our associates alike—is what we do

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Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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