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Become a part of our caring community and help us put health first

Join Humana’s dynamic Puerto Rico team as a Claims Research & Resolution Representative and make a meaningful impact every day! In this vital role, 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 leverage your expertise and independent judgment to investigate cases, approve settlements, and navigate complex administrative challenges. This position offers the opportunity to collaborate with dedicated associates, exercise your problem-solving skills, and play a key role in driving operational excellence. 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.

+ Works with providers, members, and third-party collection services to facilitate timely and accurate resolution of complex medical claims.

+ Utilizes in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards.

+ Collaborates with specialized team of claims, call center, and provider associates to conduct research and analysis on pending claims issues.

+ Applies advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects.

+ Demonstrates a high level of autonomy, leveraging experience and organizational knowledge to resolve claims inquiries.

Use your skills to make an impact

Required Qualifications

+ Must currently reside in Puerto Rico.

+ 1 year of claims or customer service experience.

+ Capacity to maintain confidentiality.

+ Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. See _Additional Information_ on testing.

Preferred Qualifications

+ Prior claims processing experience.

+ Knowledge of healthcare terminology.

Additional Information

+ **Workstyle:** Remote, work from home

+ **Work Location:** must currently reside in Puerto Rico.

+ **Required work schedule:** Monday – Friday, 8:00 am – 5:00 pm Eastern Time Zone (EST). No time off is allowed within the first 90 days of employment.

Language Proficiency Testing

Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Work at Home Guidance

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.

+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ 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.

Interview Process

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

+ **Video Prescreen** : Shortly after submitting your application, you may receive both a text message and email requesting you complete a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.

+ **Interviews** : Some candidates will be invited to interview. If so, the recruiter will reach out to schedule.

+ **Offers** : Finalists from the interview will be contacted by a recruiter to discuss an offer for the job

+ **Note** : Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

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.

$34,400 - $45,000 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to 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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.