**Description** The Bilingual Claims Research and Resolution Representative 2 address customer needs which may include complex financial recovery questions, and resolving issues. Records details of inquiries, comments or complaints, transactions or interactions and takes action in accordance to it. Escalates unresolved and pending customer inquiries How we Value You Benefits starting day 1 of employment Competitive 401k match Generous Paid Time Off accrual Tuition Reimbursement Parent Leave Go365 perks for well-being **Responsibilities** **Where you Come In** The Bilingual Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. 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. **Key Responsibilities** * Address incoming telephone, digital, or written inquiries for Puerto Rico providers as a primary task. * Assist with Medicaid incoming calls and inventory on the different intake venues * Escalate complex and unable to resolve inquiries through proper channels This position reports to the Claims Research and Resolution Supervisor, CCM Service Experience and work closely with all teams in the Customer Service Shared Services department, while potentially collaborating across CCM. This position represents the company by addressing incoming telephone, digital, or written inquiries. **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Required Qualifications - What it takes to Succeed** * Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. * Strong knowledge in different computer operating systems * Previous Call Center or related customer service experience * Capacity to maintain confidentiality * Schedule: 8:00am-4:30pm EST, Overtime as needed based on business needs * Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** * High School Diploma, GED or job related certification * Bachelor's Degree * Prior claims processing experience * Prior financial recovery experience **Additional Information - How we Value You** * Benefits starting day 1 of employment * Competitive 401k match * Generous Paid Time Off accrual * Tuition Reimbursement * Parent Leave * Go365 perks for well-being * Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work. * Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M _Please be advised, Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Candidates must be tested in ALL languages listed on the description._ **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. \#ThriveTogether #WorkAtHome **Scheduled Weekly Hours** 40 <>
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