Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Claims Research & Resolution Representative, Level 3
🕒 June 17
🇵🇷 Puerto Rico – Remote
💵 $34.4k - $45k / year
⏰ Full Time
🟢 Junior
📋 Claims Specialist
🚫👨🎓 No degree required
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Humana
10,000+ employees
Founded 1961
⚕️ Healthcare Insurance
Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
📋 Description
• 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
🎯 Requirements
• 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
🏖️ Benefits
• 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
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