Claims Processing Representative 2
About the position The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Claims Processing Representative 2 determines whether to return, deny, or pay claims following organizational policies and procedures. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Requirements • MUST reside within 50 miles (80.5 km) of the following Humana location: 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 Nice-to-haves • 1+ years of experience within the healthcare and/or insurance industries • Must be passionate about contributing to an organization focused on continuously improving consumer experiences • CAS Claims processing experience Benefits • Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Apply tot his job