Bilingual Claims Review Representative 3

Humana • Puerto Rico, TX

3d • $35,900 - $48,200 • Remote

About The Position

The Claims Review Representative 3 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. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Requirements

• Fully Bilingual in Spanish/English. Must be able to speak, read and write in the Spanish and English language without limitations or assistance.
• 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
• Must reside in Puerto Rico only

Nice To Haves

• CAS and/or CCP experience
• CIS/CIS Pro experience
• Finance Knowledge

Responsibilities

• Partner with professional staff on pre-screening review by applying guidance.
• Make appropriate decisions which may include interpretation of provider information or data.
• Focus on methods, tactics and processes for completing administrative tasks/projects.
• Exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques.
• Work under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed