[Remote] Subrogation Professional II at Humana

Puerto Rico

Apply Now

Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Significant subrogation claims handling experience in healthcare, property and casualty, or worker's compensation insurance
Strong Microsoft Office proficiency — ability to create forms, reports, and documents in Word, Excel, and/or Power BI
Strong written and verbal communication skills
Highly analytical and tech-savvy
Strong organizational abilities
Ability to manage multiple time sensitive tasks
Excellent ability to interact with associates at all levels of the organization
Work-At-Home Requirements: 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); Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

Identifies, investigates, and collects recoveries from third parties who are legally responsible for paying all or part of medical expenditures for an organization that provides health insurance
Interacts with attorneys and third-party insurance professionals to explore where there may be liability and negotiate and coordinate claim payments
Ensures Coordination of Benefits (COB) records for members who have other insurance coverage are up to date
Responds to subrogation inquiries regarding third-party liability policies and procedures
Conducts tasks and assignments as directed and understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
Makes decisions regarding their own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
Follows established guidelines/procedures

Skills

Subrogation

Claims Handling

Healthcare Insurance

Coordination of Benefits

Microsoft Excel

Microsoft Word

Power BI

Analytical Skills

Negotiation

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.

Land your dream remote job 3x faster with AI

Try Jobo Free