Claims Review Representative 3

Humana•Puerto Rico, TX

2d•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
Ability to quickly learn new systems
Ability to manage and prioritize tasks based on business need
Must reside in Puerto Rico only
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: · At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested · Satellite, cellular and microwave connection can be used only if approved by leadership
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

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

Responsibilities

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.
Focuses decisions 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.
Works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Benefits

Excellent professional development & continued education
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance