Claims Research & Resolution Representative

Humana • Puerto Rico, TX

1d • $34,400 - $45,000 • Remote

About The Position

Join Humana's dynamic Puerto Rico team as a Claims Research & Resolution Representative and make a meaningful impact every day! You'll be at the heart of our claims operations—connecting with providers and members to resolve and settle claims that shape the health industry. You'll use your expertise to investigate cases, approve settlements, and navigate complex administrative challenges. If you thrive in a fast-paced environment and enjoy making decisions that matter, Humana invites you to bring your initiative and experience to our mission-driven team.

Requirements

• MUST currently reside in Puerto Rico
• 1+ years of claims OR customer service experience.
• Must be able to communicate effectively in English, including speaking, reading, and writing, to perform the essential functions of the role. Final selected candidates will be required to complete a language proficiency assessment.

Nice To Haves

• Knowledge of healthcare terminology
• Prior claims processing experience

Responsibilities

• Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.
• Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.
• Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues.
• Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.
• Demonstrate a high level of autonomy, applying experience to resolve claims inquiries.

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