Bilingual Claims Research & Resolution Representative 2

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first! The Bilingual Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and resolution of claims or claims-related financial issues. This position involves moderately complex call center, administrative, operational, and customer support assignments. The workload typically includes semi-routine assignments along with intermediate-level math computations. This is an opportunity to work remotely and utilize your research, resolution, and customer service skills to join a Fortune 100 company with a great culture and outstanding benefits. Humana values associate engagement and well-being, and we provide excellent professional development and continued education.

Start Date: Monday, August 11th Training Period: 8-10 weeks. Perfect attendance is required for success. No PTO will be granted during this time.

The claims inbound call center is comprised of associates who research and resolve pending calls and claims. The Bilingual Claims Research & Resolution Representative 2 works with English and Spanish speaking providers, members, insurance companies, and collection services in the resolution of claims and claims-related financial issues.

Responsibilities

• Take inbound calls to address customer needs, which may include complex financial recovery, answering questions, and resolving issues.
• Record detailed notes of inquiries, comments, complaints, transactions, or interactions and take appropriate action.
• Escalate unresolved and pending customer inquiries.
• Make decisions focused on the interpretation of area or department policy and methods for completing assignments.
• Work within defined parameters to identify work expectations and quality standards, with some latitude over prioritization and timing, and under minimal direction.

Requirements

• 1 or more years of Call Center or Telephonic customer service experience (within the past 5 years).
• Previous healthcare-related experience or related education.
• Bilingual in Spanish and English (Language Proficiency Testing required).
• Basic Microsoft Office skills (Word, Excel, Outlook, and Teams).
• Strong technical skills with the ability to work across multiple software systems.
• Capacity to maintain confidentiality while working remotely from home.
• Self-reliance with the ability to resolve issues independently with minimum supervision.
• Ability to use internal system resources (e.g., Mentor) to find resolutions or respond to inquiries.
• Demonstrated time management and prioritization skills.
• Ability to manage multiple or competing priorities.

Training Details

• Virtual training starts on day one of employment (Monday, August 11th) and will run for the first 8 to 10 weeks.
• Training Schedule: 8:00 AM to 4:30 PM Eastern, Monday - Friday.
• Attendance is vital for success; no time off will be allowed during training.
• The initial 120 days of employment constitute an appraisal period, essential for learning and development. Perfect attendance is required during both classroom training and nesting periods.
• This position requires learning many systems, policies, and tools, and proficiency takes time.
• You must be willing to remain in this position for a period of eighteen (18) months before applying to other Humana opportunities.

How We Value You!

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parental Leave.
• Numerous well-being programs.

Use your skills to make an impact!