Claims Processing Representative 2

Become a part of our caring community and help us put health firstThe 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.Use Your Skills To Make An ImpactThis position is scheduled to start on January 26th, 2026***Required QualificationsMUST reside within 50 miles (80.5 km) of the following Humana location: 383 Ave Fd Roosevelt, San Juan, PR 00918, Puerto RicoAnalytical thinking skills and comfortable working independently and with minimal supervisionPrior 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 skillsProficiency in all Microsoft Office: Word, PowerPoint, ExcelPreferred Qualifications1+ years of experience within the healthcare and/or insurance industriesMust be passionate about contributing to an organization focused on continuously improving consumer experiencesCAS Claims processing experienceRequired Work ScheduleTraining: This position is scheduled to start on January 26th, 2026, Virtual training starts day one of employment and will run for 6 weeks with a schedule of 8:00AM-4:30PM Eastern Monday – Friday (9:00AM-5:30PM AST during Daylight Saving Time). You must be on time, in a quiet environment, dressed appropriately, with your camera ON during training and for other meetings required by leadership.Work Schedule Following TrainingFollowing training, associates are required to have flexibility to work 8:00AM-4:30PM (9:00AM-5:30PM AST during Daylight Saving Time).The initial 120 days of employment constitute an appraisal period.  This Appraisal Period is essential to your learning and development, which is why we ask for perfect attendance during both the classroom training and nesting periods. The department has a strict attendance policy. Time off is not permitted during the first 90 days and is discouraged during the 120-day appraisal period.This position requires learning many systems, policies, and tools, and it takes time to become proficient in the role. You must be willing to remain in this position for a period of twelve (12) months before applying to other Humana opportunities.Remote Work At Home RequirementsTo 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 connection. Wireless, satellite, cellular and microwave connections are not permitted.Humana 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 InformationPLEASE MAKE SURE YOU ATTACH YOUR RESUME IN ENGLISH TO YOUR APPLICATION (PDF OR WORD FORMAT) ** We are only considering candidates who currently reside in San Juan, PRThis position is scheduled to start on January 26th, 2026Any 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 Interview ProcessAs part of our hiring process for this opportunity, we will be using technology called HireVue to enhance our hiring and decision-making ability. HireVue 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. Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.Video Prescreen: You will receive another 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 reach out to schedule.Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the jobNOTE: 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 we are working hard to proceed as quickly as possible and to keep you informed.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$30,000 - $39,200 per yearDescription Of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) 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 outside of work. Among our 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.About UsHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana 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 base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.