About Humana


Job Category:

Consumer Service Operations - Claims Audit/Financials


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Claims Review Representative 3

Humana - San Juan Rico, United States

Posted: 07/26/2018


The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.


The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.


Required Qualifications

  • High School Diploma or equivalent
  • 1-3 years of technical experience
  • Less than 2 years of leadership experience
  • Strong and proven experience with processing and adjudicating medical claims
  • Proficiency in Microsoft Office applications including Word, Excel and Outlook
  • Working knowledge of computers or a demonstrated technical aptitude
  • Ability to quickly learn new systems
  • Ability to manage and prioritize tasks based on business need

Preferred Qualifications

  • Associate's or Bachelor's Degree
  • Knowledge with CPT and ICD9 terminology/codes
  • CAS and/or CCP experience
  • CIS/ CIS Pro experience

Additional Information

Scheduled Weekly Hours


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