[Hiring] Bilingual Claims Review Representative 3 @Humana

Role Description

The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance and making appropriate decisions, which may include interpretation of provider information or data. Decisions typically focus on methods, tactics, and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques, and works under limited guidance due to previous experience and breadth and depth of knowledge of administrative processes and organizational knowledge.

Qualifications

• Fully Bilingual in Spanish/English; must be able to speak, read, and write in both languages without limitations or assistance.
• Minimum of 1 year of strong and proven experience with processing and adjudicating medical claims.
• Knowledge of CPT, ICD9, and ICD10 terminology/codes.
• Proficiency in Microsoft Office applications including Word, Excel, and Outlook.
• Must reside in Puerto Rico only.

Requirements

• CAS and/or CCP experience (preferred).
• CIS/CIS Pro experience (preferred).
• Finance knowledge (preferred).
• Work at Home Requirements:
  • Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested.
  • Must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• 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.
• Many other opportunities supporting whole-person well-being.

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.

$35,900 - $48,200 per year