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The CarePlus Medicare Call Center Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries from Medicare members. The CarePlus Medicare Call Center Rep performs varied activities and moderately complex administrative / operational / customer support assignments. Performs computations. Typically works on semi-routine assignments.
In this position, you will strive to provide our CarePlus Medicare members with a resolution or pathway to resolution on each call, while providing a perfect call experience.
Among other responsibilities, you will address member needs which may include complex benefits questions, resolving issues, and educating our members.
You will handle 20 to 35 inbound calls daily from Medicare members with a focus on high-quality service and one-call resolution. This is a high-volume call center setting, which may be stressful at times.
As a CarePlus Medicare Call Center Rep, you will receive inbound calls; 60% to 70% of them require you to place outbound calls to physicians, DME vendors, pharmacies or other entities to help members.
You will accurately record details of inquiries, comments or complaints, transactions, or interactions, and take appropriate action accordingly. Decisions are typically focused on interpretation of area / department policy and methods for completing assignments.
You will be responsible for escalating unresolved and pending customer grievances.
You will work under minimal direction within defined parameters to identify work expectations and quality standards but will have some latitude over prioritization / timing.
You will follow standard policies / practices that allow for some opportunity for interpretation / deviation and / or independent discretion.
Requires strong emotional intelligence to proactively provide solutions, ensuring the member's utmost health and safety.
Use your skills to make an impact
Required Work Schedule
Projected start date: October 26, 2026.
Virtual training will start on day one of employment and runs for the first 7 weeks, working any shift between the hours of 8:00 AM and 8:00 PM Eastern Time (9:00 AM to 9:00 PM AST during Daylight Saving Time), Monday through Friday, based on business needs.
Following training, you will be assigned to an 8-hour shift between the hours of 8:00 AM and 8:00 PM Eastern Time (9:00 AM to 9:00 PM AST during Daylight Saving Time), Monday through Friday.
You must have the flexibility to work weekends, holidays and/or mandatory overtime, based on business needs.
This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities.
Required Qualifications
You must currently live in the Commonwealth of Puerto Rico.
You must be fully Bilingual in English / Spanish with the ability 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 Language Proficiency Testing below).
You have 1+ years of customer service experience
You have demonstrated experience with providing strong customer service, using effective communications skills and strong attention to detail while also actively listening to their needs.
You must have prior experience managing multiple or competing priorities, including use of multiple computer applications / systems simultaneously.
You must be proficient with Microsoft Office applications, particularly Outlook and Teams
Ability to maintain a professional demeanor, practicing strict confidentiality for all sensitive information.
You must take strong initiative with the ability to adapt to change quickly and be empathetic.
Preferred Qualifications
Associate or Bachelor's degree
Previous call center or related customer service experience
Previous experience with case management processes
Previous healthcare experience
Pay Rate
Internet Connection; Potential In-Office Requirement
Associates in this role are required to be hard-wired to their internet connection. Wireless, satellite, cellular, and microwave connections are NOT permitted.
Please note this position allows you to work at home until further notice; there is a possibility of this opportunity returning to a physical office at a future date, to be determined by leadership.
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.
Additional Information
**PLEASE MAKE SURE YOU ATTACH YOUR RESUME ( IN ENGLISH, PLEASE ) TO YOUR APPLICATION (PDF OR WORD FORMAT) **
Selection Process
Time off and scheduled obligations during the first 120 days will be evaluated as part of the selection process. Training and onboarding for this position is critical for associate development.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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.
$31,200 - $39,500 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, 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.