[Remote] Subrogation Representative III at Humana

Puerto Rico

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Minimum 1 year of experience in healthcare and/or subrogation experience in the property, casualty, or worker’s compensation fields
Minimum 2 years of experience in a call center and/or production environment
Strong Microsoft Office Proficiency – ability to create forms, reports, and documents in Word and Excel
Strong typing and computer navigation skills, including use of multiple computer applications simultaneously
Capacity to maintain confidentiality
Ability to manage multiple time sensitive tasks
Strong written and verbal communication skills
Strong organizational abilities
Work-At-Home Requirements: At minimum, a download speed of 25 mbps and an upload speed of 10 mbps (wireless, wired cable or DSL connection suggested; satellite, cellular and microwave only if approved); work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Responsibilities

Identifies, investigates, and collects recoveries from third parties legally responsible for paying all or part of medical expenditures for a health insurance organization
Interacts with attorneys and third-party insurance professionals to explore liability and negotiate/ coordinate claim payments
Ensures Coordination of Benefits (COB) records for members with other insurance coverage are up to date
Responds to subrogation inquiries regarding third-party liability policies and procedures
Performs advanced administrative/operational/customer support duties requiring independent initiative and judgment
Applies intermediate mathematical skills
Conducts tasks and assignments as directed, understanding department, segment, and organizational strategy and operating objectives
Makes decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction and guidance where needed
Follows established guidelines/procedures

Skills

Subrogation

Healthcare Claims

Coordination of Benefits

Microsoft Excel

Microsoft Word

Call Center

Negotiation

Insurance Recovery

Third-Party Liability

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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