Healthcare Insurance Eligibility Specialist
Welcome to Humana, a leading healthcare company dedicated to improving the health and well-being of our members. We are currently seeking a Healthcare Insurance Eligibility Specialist to join our team. In this role, you will play a crucial part in ensuring our members have access to the healthcare services they need by verifying their eligibility and benefits. To excel in this position, you must have a strong understanding of insurance eligibility and claims processes, excellent communication skills, and a passion for helping others. If you are looking for a rewarding career in the healthcare industry, we would love to have you on our team.
- Verify Member Eligibility: The Healthcare Insurance Eligibility Specialist will be responsible for verifying the eligibility of Humana members to ensure they have access to the healthcare services they need.
- Understand Insurance Processes: The specialist must have a strong understanding of insurance eligibility and claims processes to accurately verify member eligibility and benefits.
- Communicate with Members: The specialist will communicate with members to gather necessary information and explain their eligibility and benefits.
- Collaborate with Team Members: The specialist will work closely with other team members to ensure accurate and timely verification of member eligibility.
- Maintain Documentation: The specialist will maintain accurate documentation of member eligibility and benefits verification for reference and auditing purposes.
- Stay Up-to-Date on Insurance Changes: The specialist will stay updated on any changes in insurance eligibility and benefits to ensure accurate verification for members.
- Provide Excellent Customer Service: The specialist will provide excellent customer service to members by addressing any questions or concerns they may have regarding their eligibility and benefits.
- Ensure Compliance: The specialist will ensure compliance with all regulatory and company policies and procedures related to verifying member eligibility.
- Handle Inquiries: The specialist will handle inquiries from members, healthcare providers, and internal stakeholders regarding member eligibility and benefits.
- Contribute to Team Success: The specialist will contribute to the overall success of the team by meeting individual and team goals related to member eligibility and benefits verification.
Knowledge Of Healthcare Insurance: The Ideal Candidate Should Have A Thorough Understanding Of Healthcare Insurance, Including Different Types Of Plans, Coverage Options, And Eligibility Requirements. This Knowledge Will Be Essential In Accurately Determining Eligibility For Humana's Insurance Products.
Experience With Eligibility Verification: Prior Experience In Eligibility Verification, Preferably In A Healthcare Setting, Is An Important Qualification For This Role. The Candidate Should Be Familiar With Various Methods Of Verifying Eligibility, Such As Reviewing Enrollment Forms, Conducting Online Searches, And Communicating With Insurance Providers.
Strong Analytical Skills: As An Eligibility Specialist, The Candidate Will Be Responsible For Reviewing And Analyzing Complex Eligibility Data. The Ability To Interpret This Data Accurately And Identify Potential Discrepancies Is Crucial For This Role. Strong Analytical Skills Will Also Come In Handy When Resolving Eligibility Issues And Making Recommendations For Process Improvements.
Attention To Detail: Given The Sensitive Nature Of Healthcare Insurance, It Is Imperative That The Eligibility Specialist Pays Close Attention To Detail. This Includes Carefully Reviewing Eligibility Documentation, Accurately Recording Information, And Ensuring Compliance With Regulatory Requirements.
Communication And Interpersonal Skills: The Eligibility Specialist Will Be Required To Interact With A Variety Of Stakeholders, Including Patients, Healthcare Providers, And Internal Teams. Excellent Communication And Interpersonal Skills Are Essential For Building Relationships, Resolving Conflicts, And Providing Exceptional Customer Service. The Candidate Should Also Be Proficient In Written Communication For Accurately Documenting Eligibility Determinations And Reporting On Eligibility Trends.
Communication Skills
Data Entry
Multitasking
Attention to detail
customer service
Claims Processing
Medical Terminology
Teamwork
Problem-Solving
Insurance Knowledge
Eligibility Verification
Communication
Conflict Resolution
Customer Service
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Healthcare Insurance Eligibility Specialist is between $30,000 and $50,000 per year. However, this range may vary depending on factors such as location, experience, and education level. Some specialists may also receive additional benefits such as health insurance, retirement plans, and bonuses.
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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.
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