The Dental Claims Processing Representative 2 is responsible for reviewing, adjudicating, and making determinations on complex and specialty claims, received either on paper or electronically, in accordance with organizational policies and procedures. This is a production-focused role with clearly defined quality and productivity metrics that must be met. The representative interprets departmental policies to decide whether claims should be returned, denied, or paid, and performs a variety of moderately complex administrative, operational, and customer support activities, including calculations and semi-routine tasks.
Working within defined parameters, the Dental Claims Processing Representative 2 exercises some discretion in prioritizing and timing assignments, operating under minimal direction. While standard policies and practices guide most decisions, there is opportunity for interpretation and independent judgment to ensure accuracy and compliance. Consistent achievement of high-quality outcomes is expected in alignment with Humana’s values and performance standards.
Required Qualifications:
Less than 3 years of technical experience
Proficiency in all Microsoft Office: Word, PowerPoint, Excel, and Access
CAS Claims processing experience