Claims Research & Resolution Representative

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $34.4k - $45k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Resolve complex medical claims for providers, members, and third-party collection services • Investigate claims discrepancies and verify documentation • Ensure compliance with internal policies and regulatory standards • Collaborate with claims, call center, and provider associates on pending claims issues • Apply judgment and discretion to determine methods, strategies, and workflows for administrative tasks and projects • Resolve claims inquiries autonomously • Attend required virtual training and post-training support • Work a 40-hour weekly schedule within specified Eastern Time hours

🎯 Requirements

• Must currently reside in Puerto Rico • 1+ years of claims OR customer service experience • Must communicate effectively in English, including speaking, reading, and writing • Must complete a language proficiency assessment if selected • Knowledge of healthcare terminology preferred • Prior claims processing experience preferred • Must attend virtual training Monday through Friday, 8:00 am–5:00 pm Eastern Time for approximately 8 weeks • No time off allowed during training or the first 120 days • Must work Monday through Friday between 6:00 am and 5:30 pm Eastern after training and post-training support • Must remain in the position for 18 months before applying to other Humana opportunities • Internet service with minimum 25 Mbps download and 10 Mbps upload speeds • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support • Smart healthcare decision support • Occasional travel to Humana offices for training or meetings may be required