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Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
The Disenrollment Call Center Representative represents Humana by addressing incoming telephone, digital, or written inquiries from Medicare members. These Call Center Representatives strive to provide the member a resolution or pathway to resolution on each call while providing a perfect call experience. These roles will be on a Sunday thru Saturday (7 Days a week) schedule with shifts between 7:45 AM – 11:00 pm EST. This is a seasonal role with an opportunity to be permanent.
Responsibilities
What we need your help with:
The Disenrollment Call Center Representative addresses customer needs which may include complex benefit questions, resolving issues, and educating members.
Handle 30-40 inbound calls daily from members in a fast-paced inbound call center environment
Records details of inquiries, comments or complaints, transactions, or interactions and takes action in accordance with it.
Escalates unresolved and pending customer grievances. Decisions are typically focused on the interpretation of area/department policy and methods for completing assignments.
Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing and works under minimal direction.
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
What you need for success! – Required Qualifications
Minimum 2 years of customer service experience
Must be available to work any shift between the hours of 7:45 am – 11:00 pm EST (Sun-Sat) as well as weekends and overtime, especially during our peak season of October-March and as needed by the business.
Training is work at home or virtual. Training will start day one of employment and run the first 6 weeks with a schedule of 8:00 am – 4:30 pm EST. Attendance is vital for success so no time off is allowed during training.
Core business hours align to Eastern Standard Time (EST)
Demonstrated experience with providing strong customer service and attention to detail while listening to calls
Prior experience managing multiple or competing priorities, including the use of multiple computer applications simultaneously
Prior experience effectively communicating with customers verbally and listening to their needs
If the residence is within a 50-mile radius of a Humana office location, you may be asked to occasionally report to that office for meetings, business functions, etc. once CDC restrictions have been lifted.
Associates working in the state of Arizona must comply with the Tobacco-Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
Work at Home Requirements
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
What you need to be STAND OUT among the crowd!: Preferred Qualifications
Associate's or Bachelor's Degree
Prior inbound call center or related customer service experience
Prior Healthcare experience.
Work at Home nationwide
AL; AZ; AR; CA; CO; CT; DE; DC; FL; GA; ID; IL; IN; IA; KS; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OH; OK; OR; PA; RI; SC; SD; TN; TX; UT; VT; VA; WA; WI;
Responsibilities
The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ensuring the best and most appropriate treatment, care or services for members. Decisions typically focus on the interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Required Qualifications
1 or more years administrative or technical support experience
Excellent verbal and written communication skills
Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment and an ability to quickly learn new systems
Must have accessibility to high-speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed is 10Mx1M
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Proficient in utilizing electronic medical record and documentation programs
Proficient and/or experience with medical terminology and/or ICD-10 codes
Prior member service or customer service telephone experience desired
Experience with Utilization Review and/or Prior Authorization, preferably within a managed care.
AL; AK; AZ; AR; CA; CO; CT; DE; DC; FL; GA; HI; ID; IL; IN; IA; KS; KY; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OH; OK; OR; PA; RI; SC; SD; TN; TX; UT; VT; VA; WA; WI; PR;
Responsibilities
Where you Come In The Bilingual Claims Research & Resolution Representative 2 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 to a pending call. Decisions typically focus on the interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Key Responsibilities • Address incoming telephone, digital, or written inquiries for Puerto Rico providers as a primary task. • Assist with Medicaid incoming calls and inventory on the different intake venues • Escalate complex and unable to resolve inquiries through proper channels
This position reports to the Claims Research and Resolution Supervisor, CCM Service Experience, and work closely with all teams in the Customer Service Shared Services department, while potentially collaborating across CCM. This position represents the company by addressing incoming telephone, digital, or written inquiries.
What Humana Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications – What it takes to Succeed • Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. • Strong knowledge of different computer operating systems • Previous Call Center or related customer service experience • Capacity to maintain confidentiality • Schedule: 8:00 am-4:30 pm EST, Overtime as needed based on business needs • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications • High School Diploma, GED or job-related certification • Bachelor's Degree • Prior claims processing experience • Prior financial recovery experience
Additional Information – How we Value You • Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave • Go365 perks for the well-being
• Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work. • Must have accessibility to high-speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role), and recommended speed for optimal performance from Humana systems is 10M x 1M.
AL; AK; AZ; AR; CA; CO; CT; DE; DC; FL; GA; HI; ID; IL; IN; IA; KS; KY; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OK; OR; PA; RI; SC; SD; TN; TX; UT; VT; VA; WA; WV; WI; WY; PR;
Responsibilities
The Inbound Contacts Representative 2 represents Humana by addressing incoming telephone, digital, or written inquiries from Medicare Members. The Inbound Contact Representative 2 strives to provide resolution or pathway to resolution on each call while providing a perfect call experience. These roles will be on a Monday-Friday schedule with shifts between 7:45 am – 9:00 pm EST (M-F), some weekends during peak season.
What we need your help with:
The Inbound Contact Representative 2 addresses customer needs which may include complex benefit questions, resolving issues, and educating members.
Handle 40-50 inbound calls daily from members in a fast-paced inbound call center environment
Records details of inquiries, comments or complaints, transactions or interactions and take action in accordance with it.
Escalates unresolved and pending customer grievances. Decisions are typically focused on the interpretation of area/department policy and methods for completing assignments.
Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing and works under minimal direction.
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
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
Minimum 2 years of customer service experience
Must be available to work any shift between the hours of 7:45 am – 9:00 pm EST (M-F), some weekends during peak season
Training is work at home or virtual. Training will start day one of employment and run the first 11 weeks with a schedule of 8:00 am – 4:30 pm EST. Attendance is vital for success so no time off is allowed during training and 50 days following.
Demonstrated experience with providing strong customer service and attention to detail while listening to calls
Prior experience managing multiple or competing priorities, including the use of multiple computer applications simultaneously
Prior experience effectively communicating with customers verbally and listening to their needs
Work at Home Requirements
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Bilingual English and Spanish
AL; AZ; AR; CA; CO; CT; DE; DC; FL; GA; ID; IL; IN; IA; KS; KY; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OH; OK; OR; PA; RI; SC; SD; TN; UT; VT; VA; WA; WI;
Responsibilities
Work Environment: This is a customer-centric member advocate environment focused on high-quality outcomes versus activities. Our department primarily communicates over the phone, but we are not a “call center” environment as we are responsible for the member’s safety and advocacy outcome as part of the continuum of their care. We value quality work as every action taken in the member services department is to facilitate access to the member and avoid adverse outcomes for the member.
Associates can expect to take anywhere from 30-35 inbound calls per day with the focus being on high-quality service with a strong emphasis on member advocacy and patient safety.
While this associate receives inbound calls, up to 50% of these calls may require associates to place outbound calls to physicians, DME vendors, pharmacies, or other entities to coordinate benefits and care for the member.
This role calls for strong emotional intelligence focused on proactively providing solutions, ensuring the member's utmost health and safety. De-escalation skills are a must to thrive in this role. We serve a wide variety of members, some of which are experiencing illness and trauma at the time of their call.
Education, Experience, Skillset:
High School Diploma or Equivalent
2+ years or more customer service experience within any of the following heavy or high volume health care, call quality, retail, and or anything involving working with an irate customer population or requiring a high degree of organization, structure, and focus.
Ability to communicate general information such as pharmacy; plan medical, dental & vision benefits
Excellent verbal and written communication skills
Ability to maintain a professional demeanor, practicing strict confidentiality on all platforms for all sensitive information
Ability to focus on the training and role without significant interruption during the workday.
Strong initiative with the ability to adapt to change as the business requires.
Must have the ability and willingness to be selfless and focus on the member as the priority throughout the workday.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Technology, System, and Platform Knowledge:
Strong computer skills and utilizing multiple systems and applications simultaneously is required. Must be comfortable with gaining new systems knowledge at all times as software is constantly updating requiring the ability to learn systems in real-time. The following is required to ensure success in the role as a remote work at home associate:
Must be proficient in Microsoft Word such as Word, Excel, Outlook/WebEx, Skype and using collaborative platforms for network sharing examples such as SharePoint, and Teams
Must have experience using vendor applications examples such as Salesforce, and department CRM Platforms.
Additional Requirements
Must be able to pass the following pre-hire assessments, (Please review in the below additional information):
Virtual Job Experience Assessment
A writing assignment may be requested during screening and/or interview
A language assessment may be performed for English and or bilingual Spanish during screen and/or interview.
Anticipated Start Date/Training Date: 26 April, 24 May
Hours – Adherence to the following schedule:
20 hours per week Monday through Friday between the hours of 8:00 AM to 8:00 PM Eastern Time
Additional hours may be offered up to 5 hours per week are available as business needs and upon leader approval
Shift assignments will be scheduled 4-6 hours daily and must be approved and will be based on business need
Training Hours:
2 to 3 Weeks training
Scheduled 8 hours between 8:00 AM to 8:00 PM Eastern Time, Monday through Friday
Location:
Remote/Work at Home ** Please review Work at Home Guidelines below**
The United States, excluding Alaska and Hawaii
Language Fluency Requirement
English fluency
Responsibilities
The Inbound Contacts Representative 1 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. Additional Information – How we Value You Benefits starting day 1 of employment Competitive 401k match Generous Paid Time Off accrual Tuition Reimbursement Parent Leave Go365 perks for the well-being
Responsibilities The Inbound Contacts Representative 1 addresses customer needs related to dental insurance and coverage. This may include:
complex benefit questions,
resolving issues, and educating members.
Records details of inquiries, comments or complaints, transactions or interactions and take action in accordance with it.
Escalates unresolved and pending customer grievances.
Decisions are limited to defined parameters around work expectations, quality standards, priorities, and timing, and works under close supervision and/or within established policies/practices and guidelines with minimal opportunity for deviation.
Required Qualifications:
Minimum 1 year within a metric and performance-based call center
Strong customer service orientation
Strong attention to detail
Strong typing and computer navigation skills
Demonstrated ability in using a computer and Windows PC applications, which includes strong keyboard and navigation skills including the ability to learn new computer programs
Effective verbal and listening communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Additional Requirements Work Style: Remote work at home Locations: Florida, Georgia, Ohio, Wisconsin Hours: Shifts will be scheduled in 8-hour increments between 7:50 AM-9:00 PM Eastern. Shift schedules are subject to change approximately every 6 months and based on business needs. Attendance Policy: The department has a strict attendance policy during the first 120 days. Time off is discouraged during this period. Remote work at home requirements:
Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you work
Must have accessibility to hardwired high-speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)
Preferred Qualifications:
Associate's or Bachelor's Degree
Healthcare experience
Fluency in Spanish
Additional Information: Resumes need to be formatted, free of spelling and grammar errors, and complete with full work history within 7-10 years. Please notate any positions that may be considered seasonal, short-term, and any reasons for gaps in work history, (pursuing education, relocated, taking care of family).
After submitting your application, if you are selected to move forward you will receive an email to complete the Virtual Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at Humana, try out some of the most common job tasks, and tell us more about yourself. Most people complete the VJE in 30 minutes. To complete it, you will need a smartphone, computer or tablet with internet access, and speakers/headphones. We do not make job offers to candidates that do not complete the VJE. The email will come from vjtadmin@mg.jobtryout.net, please add to your contacts or safe senders list to avoid this going to your spam folder.
AZ; CA; CO; ID; MT; NM; OR; UT; WA; WY;
Responsibilities
The Healthcare Call Center Lead role works as an Inbound Contacts Representative 4 addresses customer needs which may include complex benefit questions, resolving issues, and educating members. Records details of inquiries, comments or complaints, transactions, or interactions and takes action in accordance with it. Escalates unresolved and pending customer grievances. Decisions are regarding the daily priorities for an administrative workgroup and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of the main process, program, product, or technology. Works within broad guidelines with little oversight.
Required Qualifications
High School Diploma or GED
Experience working in a high volume Inbound and or outbound Call Center that may handle quality call resolution
Handling Escalation Calls
Assisting the associate and providing guidance.
Working experience in a healthcare environment
1+ years experience leading projects, subject matter expert, team lead, or prior leadership experience
Experience working in a heavy metric based environment
Intermediate or above Proficiency in Microsoft Office applications, including Outlook, Word, and Excel
Excellent verbal and written communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Reside in states that are in any Time Zones
Additional Requirements:
Hours: Must be able to work an 8-hour shift Monday through Friday between the hours of 8:00 AM to 8:00 PM Eastern Time – rotating weekends and or holidays. Hours are subject to change based on business needs – Leader will discuss during the interview
Workstyle/Location: The position will permanently report to a remote/work-at-home office.
Preferred Qualifications
Associate's or Bachelor's Degree
1+ years experience working on escalated call line, providing support to inter-department for Inbound Contact Representatives
Prior work experience in an operational setting
Previous experience with coordinating and leading projects and tasks
Bilingual (English and Spanish); with the ability to pass a language assessment
Additional information
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members, and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to:
Upon Interview
A personal computing device with a camera, a minimum internet connection speed of 10m x 1m,
A dedicated secure home workspace for interview or work purposes.
Upon Hire
Minimum internet hardwired internet speed of 10m x 1m, (Satellite, Wireless and or Hot Spot service are prohibited)
A dedicated secure home workspace for interview or work purposes.
Equipment will be provided for home office use.
Description
The Outbound Call Specialist- Dr. Call Phone Department role is a clerking role tasked with making outbound calls to local pharmacies and initiating prescription transfers that are then completed by our internal pharmacists. That looks like making as many as 35-45 outbound calls a day to retail pharmacies, collecting member data, and coordinating with Humana Pharmacy to facilitate a smooth transition of the prescriptions.
Responsibilities
The Outbound Call Specialist- Dr. Call Phone Department role is a clerking role tasked with making outbound calls to local pharmacies and initiating prescription transfers that are then completed by our internal pharmacists. That looks like making as many as 35-45 outbound calls a day to retail pharmacies, collecting member data, and coordinating with Humana Pharmacy to facilitate a smooth transition of the prescriptions. Additional responsibilities may include outbound member calls.
Required Qualifications
High school diploma or equivalent
At least 6 months in phone experience
Excellent communication skills are written and verbal
Strong typing and computer navigation skills
Capacity to multi-task, including use of multiple computer applications simultaneously
Scheduled Weekly Hours
40
(Fully Bilingual English/Spanish) San Juan, PR
Responsibilities
The Supervisor, Consumer Service Operations may perform installation, implementation, client support, client services, client administration, customer service, enrollment, eligibility, claims processing, and service operations. Decisions are typically are related to schedule, plans, and daily operations. Performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across teams. Holds team members accountable for following established policies.
Required Qualifications
Bachelor's Degree
Fully Bilingual in English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing
4 – 6 years of leadership, escalated calls experience, or team lead experience
Proficiency in all Microsoft Office programs including Word, PowerPoint, and Excel
Demonstrated capability with coaching and developing associates formally and informally
Ability to monitor and recommend improvements to increase team productivity by providing expert advice and assistance to other associates, as needed
Previous experience with coordinating and leading projects and tasks
Understands upstream and downstream impacts
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Work At Home requirements (Temporary due to COVID-19): Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Experience working in a call center or production environment
Prior work in a Healthcare operational setting
Proficiency in Microsoft Access
Additional information
Schedule: Monday to Friday from 8 am to 5 pm.
Training: 2-4 weeks – Remotely
Work Location (Address): This permanent job is working from home temporarily due to Covid 19 emergency. This position will deploy to the following location at a future date: 383 Ave F D Roosevelt Ave. San Juan, PR 00918
% Travel: none
# of Direct Reports: 10
Language Proficiency Testing (English/Spanish): Any Humana associate who speaks with a member in a language other than Spanish and/or 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
Spanish/English – San Juan, Puerto Rico
Responsibilities
Decisions are typically focused 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.
Required Qualifications
At least 1 year of telephonic customer service experience
1 – 3 years of technical experience with knowledge of Microsoft Office Word, Excel, Outlook
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See Additional Information on testing
Preferred Qualifications
Associate or Bachelor's Degree in Business or a related field
2 or more years of demonstrated leadership experience
Administration support experience in the healthcare industry with familiarity with care and well-being resources
Additional Information
Location: Temporary work at home until Humana returns to the office in San Juan.
Language Proficiency Testing
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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