Inbound Claims & Call Center Representative (iCare) - Remote, US
Posted on: August 6, 2022
Work 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.
+ Provides 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
+ 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
+ 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.
+ 2-3 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
+ Experience in managed health care systems and customer service
+ 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
+ Experience in the use of a personal computer and software
applications, including Microsoft Windows and Microsoft Office
+ 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.
+ Bi-lingual - English, Spanish preferred.
+ Previous experience working with Microsoft Windows, including
+ **Typical Work Hours/Days:** Monday through Friday; 8:30am - 5:00
**Full Time associates enjoy:**
+ $1000 sign-on bonus
+ Medical, Dental, Vision, and a variety of other supplemental
+ 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
**Scheduled Weekly Hours**
Keywords: Humana, Albany , Inbound Claims & Call Center Representative (iCare) - Remote, US, Other , Albany, New York
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