Bilingual Consumer Service Operations Rep

About the role

Join Humana's Infusion Pharmacy team and help patients access the medications and care they need. As a Bilingual Consumer Service Operations Representative, you will partner with providers, patients, and health plans to manage pharmacy referrals and prior authorizations for managed care members. Reporting to the Consumer Service Operations Supervisor, you will review and process health and prescription claims, ensure compliance with payer requirements, including Medicare and Medicaid guidelines, and help guide efficient, accurate service delivery. You'll serve as a trusted resource for customers and healthcare providers, resolve complex issues, support audits and special projects, and contribute to team success by mentoring and training colleagues.

Responsibilities

• Independently follow up on pending orders, including Member Liability and Health Plan authorizations.
• Submit test claim based on prescription request collaborating with the Pharmacy department.
• Work rejections directly with the health insurance company.
• Use telephone or computer systems to obtain additional information and payments.
• Request Prior authorizations.
• Participate in special projects and other assigned tasks.

Requirements

• Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance.
• Minimum of 1 year of customer service experience.
• Experience learning and navigating new technology systems.
• Proficient in Microsoft Office Outlook and Word.

Preferred Qualifications

• Pharmacy Technician certification.
• Previous health insurance experience.

Schedule

The Infusion Pharmacy is open Monday–Friday, 8:00 AM–9:00 PM, Saturday 9:00 AM-6:00 PM, and Sunday, 10:00 AM–7:00 PM. You will follow a rotating schedule, with shifts assigned across the hours of operation and including both weekday and weekend coverage.

Scheduled Weekly Hours: 40

Workstyle: Hybrid (required to be in office one day per week in Miramar, FL).

Pay

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$40,000 - $52,300 per year

Benefits

Humana offers competitive benefits that support whole-person well-being. Associate benefits include:

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance

About Us

About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient-focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.