Bilingual Claims Review Representative 3
About the role
The Claims Review Representative 3 collaborates with professional staff on pre-screening reviews, applying guidance and making appropriate decisions. This includes interpreting provider information or data and working under limited guidance.
Responsibilities
- Apply guidance and make appropriate decisions during pre-screening reviews
- Interpret provider information or data as needed
- Prioritize requests and adapt procedures, processes, and techniques
- Work under limited guidance due to previous experience and breadth/depth of knowledge
Requirements
- Fully bilingual in Spanish/English
- Minimum of 1 year of strong and proven experience with processing and adjudicating medical claims
- Knowledge with CPT, ICD9, and ICD10 terminology/codes
- Proficiency in Microsoft Office applications including Word, Excel, and Outlook
- Reside in Puerto Rico only
Preferred Qualifications
- CAS and/or CCP experience
- CIS/CIS Pro experience
- Finance Knowledge
Benefits
Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, a 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and many other opportunities. Associates have the option to work remotely and must provide a dedicated space to protect member PHI/HIPAA information.
Schedule
This is a remote position, with occasional travel to Humana's offices for training or meetings.
Pay Range
The compensation range for this position is $35,900 - $48,200 per year.
About Us
Humana, Inc. is a leading U.S. healthcare company offering comprehensive benefits to its associates and customers. We make healthcare accessible and affordable through our insurance services and healthcare services, ensuring better quality of life for those with Medicare and Medicaid, families, individuals, military service personnel, and communities.
Equal Opportunity Employer
Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We take affirmative action to employ and advance in employment individuals with disabilities and protected veterans.