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Become a part of our caring community
Join Humana's dynamic Puerto Rico team as a Claims Research & Resolution Representative and make a meaningful impact every day! You'll be at the heart of our claims operations-connecting with providers and members to resolve and settle claims that shape the health industry. You'll use your expertise and independent judgment to investigate cases, approve settlements, and navigate complex administrative challenges. We offer the opportunity to collaborate with dedicated associates, exercise your problem-solving skills, and play a key role in driving operational excellence. If you thrive in a fast-paced environment and enjoy making decisions that matter, Humana invites you to bring your initiative and experience to our mission-driven team.
As a Claims Research & Resolution Representative 3 you will:
Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues.
Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries.
Use your skills to make an impact
Required:
MUST reside in Puerto Rico
1+ years of claims OR customer service experience.
Capacity to maintain confidentiality.
Must be able to speak, read and write in English without limitations or assistance.
Preferred:
Bachelor's Degree
Knowledge of healthcare terminology
Prior claims processing experience
Required Work Schedule:
Training:
Training starts on day one and runs for 8 weeks with a schedule of Monday - Friday, 8:00 am - 5:00 pm Eastern Time Zone (EST).
Attendance is vital for success; other than Humana-observed holidays, no time off is allowed during training.
Post Training:
Following training, associate will work Monday - Friday, 8:00 am - 5:00 pm Eastern Time Zone (EST) .
No time off is allowed within the first 90 days of employment.
You will be a part of a probationary period for nine (9) months. During which you and the manager assess how well you meet the requirements of the new position and work with our organization.
You will learn many systems, policies, and tools, and it takes times to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities outside of this team.
Remote Work at Home Requirements
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.
Associates in this role are required to be hard-wired to their internet connection. Wireless, satellite, cellular and microwave connections are not permitted.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Additional Information
Interview Process
As part of our hiring process for this opportunity, we will use technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.
Video Prescreen: You will receive communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule.
Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job
NOTE: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$34,400 - $45,000 per year
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.