Humana Looking For Claims Review Representative 3 – Bilingual – San Juan, PR – Remote at San Juan, PR Full Time

Humana is looking to add new associate to the PrePay Audit team in San Juan, PR. This Claims Review Representative 3 opportunity is 100% work-at-home position for the San Juan, PR office. The associate will make appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. This role is involved in the pre-screening review process by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Will perform advanced administrative/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

Where you Come In

Humana is looking to add new associate to the PrePay Audit team in San Juan, PR. This Claims Review Representative 3 opportunity is 100% work-at-home position for the San Juan, PR office. The associate will make appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. This role is involved in the pre-screening review process by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Will perform advanced administrative/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Candidates will be responsible for the review of all claims identified to have a potential overpayment opportunity.

Claims are identified through queries and concepts developed in other areas within the Claims Cost Management (CCM) organization and delivered to the team via the EFR Audit Tool

Partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data.

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications – What it takes to Succeed

Fully Bilingual in English & Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English & Spanish.

Proficiency in Microsoft Office applications Word, Excel and Outlook

Experience in working under processes that require production and metrics

Prior experience with inventory management, financial administrative task or related experiences.

Must be able to work overtime when required

Schedule: Monday to Friday from 6 am to 6 pm EST

Associates earn vacation on a biweekly basis (18 days per calendar year). Vacation time can be taken after six months of employment. NO Exceptions.

Training: 4 weeks, 100% Virtual

Working knowledge of computers or a demonstrated technical aptitude

Ability to quickly learn new systems

Ability to manage and prioritize tasks based on business need

Ability to multitask within different screens or tools

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

High School Diploma, GED or job related certification

Associate’s or Bachelor’s Degree

Knowledge with CPT and ICD9 terminology/codes

Strong and proven experience with processing and adjudicating medical claims

PMHS and/or CRM experience

Additional Information – How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

• Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
• Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); a minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Not Specified

0