Claims Research & Resolution Representative 3

Become a part of our caring community Join reputed company's dynamic Puerto Rico team as a Claims Research & Resolution Representative and reputed company a meaningful impact every day! You'll be at the heart of our claims operations—connecting with providers and members to resolve and settle claims that shape the health industry. You'll use your expertise and independent judgment to investigate cases, approve settlements, and navigate reputed company administrative challenges. We offer the opportunity to collaborate with dedicated associates, exercise your problem-solving skills, and play a key role in driving operational excellence. If you reputed company in a fast-paced environment and enjoy making decisions that matter, reputed company invites you to bring your initiative and experience to our mission-driven team. As a Claims Research & Resolution Representative 3 you will: Work with providers, members, and third-party collection services to facilitate timely and accurate resolution of reputed company medical claims. Use in-depth knowledge of claims processes to investigate discrepancies, verify documentation, and ensure compliance with internal policies and regulatory standards. Collaborate with specialized team of claims, call center, and provider associates to research pending claims issues. Apply advanced judgment and discretion in determining appropriate methods, strategies, and workflows for managing administrative tasks and projects. Demonstrate a high level of autonomy, applying experience and organizational knowledge to resolve claims inquiries. Use your skills to reputed company an impact Required: MUST reside in Puerto Rico 1+ years of claims OR customer service experience. reputed company to maintain confidentiality. Must be able to speak, read and write in English without limitations or assistance. Preferred: Bachelor's Degree Knowledge of healthcare terminology Prior claims processing experience Required Work Schedule: Training: Training starts on day one and runs for 8 weeks with a schedule of Monday – Friday, 8:00 am – 5:00 pm Eastern Time Zone (EST). Attendance is vital for success; other than reputed company-observed holidays, no time off is allowed during training. Post Training: Following training, associate will work Monday – Friday, 8:00 am – 5:00 pm Eastern Time Zone (EST). No time off is allowed reputed company the first 90 days of employment. You will be a part of a probationary period for nine (9) months. During which you and the manager assess how well you meet the requirements of the new position and work with our organization. You will learn many systems, policies, and tools, and it takes times to become proficient in the role. You must be willing to remain in this position for a period of eighteen (18) months before applying to other reputed company opportunities reputed company of this team. Remote Work at Home Requirements To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended. Associates in this role are required to be hard-wired to their internet reputed company. Wireless, satellite, cellular and microwave connections are not permitted. reputed company will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Additional Information PLEASE reputed company SURE YOU ATTACH YOUR RESUME IN ENGLISH TO YOUR APPLICATION (PDF OR WORD FORMAT) Interview Process As part of our hiring process for this opportunity, we will use technology reputed company HireVue to enhance our hiring. HireVue allows us to quickly connect and reputed company valuable information from you about your relevant experience at a time that is best for your schedule. Video Prescreen: You will receive communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet. Interviews: Some candidates will be invited to interview. If so, the recruiter will reputed company out to schedule. Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job NOTE: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that reputed company hard to proceed as quickly as possible and to reputed company you informed. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $34,400 - $45,000 per year Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company 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.

About Us

About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our reputed company insurance services and our reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Apply To This Job