Healthcare Claims Denials Specialist

"Are you passionate about helping others navigate the complex world of healthcare claims? Do you have a keen eye for detail and a knack for problem-solving? Humana is seeking a highly motivated individual to join our team as a Healthcare Claims Denials Specialist. As a crucial member of our organization, you will play a vital role in ensuring accurate and timely processing of claims, ultimately improving the overall experience for our members. If you possess strong communication skills, a deep understanding of healthcare claims processes, and a commitment to delivering exceptional customer service, we would love to hear from you. Join us in making a meaningful impact on the lives of our members and become part of the Humana family."

1. Review and analyze healthcare claims to identify and resolve denials or discrepancies.
2. Communicate with healthcare providers, insurance companies, and internal departments to gather necessary information and resolve claims issues.
3. Utilize knowledge of healthcare claims processes and regulations to accurately process claims.
4. Conduct research and investigate the root causes of denials to prevent future occurrences.
5. Collaborate with team members to develop and implement strategies for improving claims processing efficiency and accuracy.
6. Maintain up-to-date knowledge of healthcare industry trends, regulations, and policies.
7. Provide exceptional customer service by responding to inquiries and concerns from members and providers in a timely and professional manner.
8. Document all activities and resolutions in the claims management system.
9. Participate in training and development opportunities to enhance skills and knowledge.
10. Identify process improvement opportunities and make recommendations for changes.
11. Adhere to company policies and procedures, as well as industry standards and regulations.
12. Meet or exceed performance metrics, including productivity and accuracy targets.
13. Maintain confidentiality of sensitive information.
14. Act as a subject matter expert and provide guidance and support to team members as needed.
15. Continuously seek ways to improve the overall member experience.

According to JobzMall, the average salary range for a Healthcare Claims Denials Specialist in Texas, USA is $50,000-$65,000 per year. This may vary depending on factors such as experience, education, location, and specific job duties. Some positions may also offer additional benefits such as healthcare, retirement plans, and bonuses. It is important to research specific job postings and negotiate salary and benefits with potential employers.

Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.