Remote Claims Research & Resolution Specialist

Humana; United States; Remote; USD 34,000 - 45,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana is seeking a Claims Research & Resolution Representative 3 in Puerto Rico to investigate complex medical claims, verify documentation, and collaborate with providers, members, and internal teams to settle cases. The role requires 1+ year experience in claims or customer service, English communication skills, and residency in Puerto Rico.

It includes virtual training starting December 2026, a 9-month probation, and a 18-month commitment, with a 40-hour work week and a $34,400 to $45,000

Qualifications

• Must reside in Puerto Rico.
• 1+ years of claims or customer service experience.
• English communication skills with proficiency assessment.

Responsibilities

• Work with providers, members, and third-party services to resolve complex medical claims.
• Investigate discrepancies, verify documentation, and ensure policy compliance.
• Collaborate with claims, call center, and provider teams to research issues.
• Apply judgment to determine methods and workflows for administrative tasks.
• Demonstrate autonomy in resolving inquiries.

Skills

Customer service

English communication

Claims knowledge

Job description

Humana is seeking a Claims Research & Resolution Representative 3 in Puerto Rico to investigate complex medical claims, verify documentation, and collaborate with providers, members, and internal teams to settle cases. The role requires 1+ year experience in claims or customer service, English communication skills, and residency in Puerto Rico.

It includes virtual training starting December 2026, a 9-month probation, and a 18-month commitment, with a 40-hour work week and a $34,400 to $45,000