Claims Processing Representative 2 at Humana

San Juan, Puerto Rico, Puerto Rico

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

MUST reside within 50 miles (80.5 km) of 383 Ave Fd Roosevelt, San Juan, PR 00918, Puerto Rico
Analytical thinking skills and comfortable working independently and with minimal supervision
Prior experience working with multiple computer systems at a time and multitasking through those effectively
Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously
Excellent verbal and written communication skills
Proficiency in all Microsoft Office: Word, PowerPoint, Excel
Flexibility to work 8:00AM-4:30PM Eastern Monday – Friday (9:00AM-5:30PM AST during Daylight Saving Time) following training
Perfect attendance during 6-week training and nesting periods; no time off in first 90 days, discouraged during 120-day appraisal period
Willingness to remain in position for 12 months before applying to other Humana opportunities
Self-provided internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps; must be hard-wired (no wireless, satellite, cellular, or microwave)
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Attach resume in English (PDF or Word format) to application

Responsibilities

Reviews and adjudicates complex or specialty claims submitted via paper or electronically
Performs varied activities and moderately complex administrative/operational/customer support assignments
Performs computations
Determines whether to return, deny, or pay claims following organizational policies and procedures
Interprets area/department policy and methods for completing assignments
Works within defined parameters to identify work expectations and quality standards, with some latitude over prioritization/timing
Works under minimal direction, following standard policies/practices with some opportunity for interpretation/deviation and independent discretion
Be on time, in a quiet environment, dressed appropriately, with camera ON during training and leadership meetings

Skills

Analytical Thinking

Claims Processing

Claims Adjudication

Multitasking

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Verbal Communication

Written Communication

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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