Bilingual Outbound Telephonic UM Coordinator

Florida, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must be bilingual in English and Spanish, with the ability to speak, read, and write both languages without limitations. A minimum of one year of experience in administrative support, healthcare, and outbound telephonic customer service is required. Proficiency in Microsoft Word, Excel, and Outlook is necessary. Candidates must reside in the Eastern Standard Time zone and be available to work Monday-Friday from 8 am to 5 pm EST, with one weekend per quarter, and potential overtime. Preferred qualifications include proficiency with documentation programs, the CarePlus Platform, medical terminology, ICD-10 codes, member service experience, and utilization review or prior authorization experience within a managed care organization.

Responsibilities

The Bilingual Outbound Telephonic UM Administration Coordinator 2 will provide non-clinical support for policies and procedures to ensure members receive the best and most appropriate treatment, care, or services. Key duties include making outbound calls to members after authorizations are processed, documenting all calls and requests, and processing and emailing member letters such as Letters of Agreement, Approvals, and Denials. The role also involves assisting the team with various clerical and administrative tasks and participating in special projects as assigned by supervisors or managers.

Skills

Bilingual English/Spanish

Administrative support

Healthcare experience

Outbound telephonic Customer Service

Microsoft Word

Microsoft Excel

Microsoft Outlook

Documentation programs

CarePlus Platform

Medical terminology

ICD-10 codes

Member service

Utilization Review

Prior Authorization

Managed care organization

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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