[Hiring] Claims Research & Resolution Representative 3 @Humana

Role Description

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.

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.

Qualifications

• 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.

Requirements

• 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.
• 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.
• 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.

Benefits

• Competitive benefits that support whole-person well-being.
• 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.

Interview Process

• You will receive communication to record a Video Prescreen.
• Some candidates will be invited to interview.
• Finalists from the interview will be contacted by a recruiter to discuss an offer for the job.

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