Claims Research & Resolution Representative 2, Medicare Secondary Payer Investigations - Bilingual - San Juan, Pr

Description The Claims Research & Resolution Representative 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Responsibilities The Claims Research & Resolution Representative 2 role will include investigating members who may have an another insurance plan in addition to their Humana plan, that needs to be properly coordinated. This will require making calls to other insurance carriers to validate the information, determining primacy, updating Humana systems and the Center for Medicaid and Medicare (CMS) systems. These updates allow for claims to be paid correctly and for Medicare membership ensures the correct premium is received from CMS. Claims will need review on occasion to ensure they were paid correctly based on the primacy updates that were made. In this role you will: Build lasting relationship with Humana's internal and external customers Educate customers, providers and employers about Humana's products and services Required Qualifications Strong written and verbal communication Professional demeanor High level of emotional intelligence Analytical and problem solving skills Bilingual English/Spanish. Candidate selected will not be communicating in English with Members. Preferred Qualifications Associate or Bachelor's Degree Working knowledge of Claims Cost Management Experience in a role requiring problem solving skills Proven initiative mentoring others Working knowledge of Coordination of Benefits (COB) Working knowledge of Medicare Secondary Payer (MSP) Working knowledge CAS Experience with CCP and/or CRM Medical claims processing and interpretation experience Reporting Relationship You will report to a FLL. Scheduled Weekly Hours 40 SDL2017