Claims Research & Resolution Representative
New
H
HumanaHealthcare claims
MUST currently reside in Puerto Rico, Training is scheduled in Eastern Time; after training, the work schedule is between 6:00 am and 5:30 pm Eastern.Full-TimeJunior
Salary34,400 - 45,000 USD per year
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Job Details
- Languages
- Must be able to communicate effectively in English, including speaking, reading, and writing.
- Experience
- 1+ years of claims OR customer service experience.
- Required Skills
- Customer service
Requirements
- Have 1+ years of claims or customer service experience.
- Communicate effectively in English in speaking, reading, and writing; selected candidates must complete a language proficiency assessment.
- Complete virtual training beginning in December 2026, lasting approximately 8 weeks, Monday through Friday, 8:00 am–5:00 pm Eastern Time.
- Be available for training and the first 120 days without taking time off.
- Be able to work Monday through Friday between 6:00 am and 5:30 pm Eastern after training and the post-training support period.
- Be willing to remain in the position for 18 months before applying to other Humana opportunities.
- Have internet service with at least 25 Mbps download and 10 Mbps upload speed.
- Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
- Knowledge of healthcare terminology is preferred.
- Prior claims processing experience is preferred.
Responsibilities
- Work with providers, members, and third-party collection services to resolve complex medical claims.
- Investigate claim discrepancies and verify documentation.
- Ensure claims handling complies with internal policies and regulatory standards.
- Collaborate with claims, call center, and provider associates to research pending claims issues.
- Use judgment and discretion to determine methods, strategies, and workflows for administrative tasks and projects.
- Resolve claims inquiries autonomously.
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