Claims Review Rep 3 -remote In Pr

HumanPanorama

San Juan, PR, US
Base: $35,900 - $48,200 py; bonus/equity: not spec...
Hybrid
Fully bilingual in english and spanish
Experience processing medical claims
Knowledge of cpt and icd-9 terminology
This role involves reviewing all claims identified with potential overpayment opportunities using the EFR Audit Tool

Job Summary

  • This role involves reviewing all claims identified with potential overpayment opportunities using the EFR Audit Tool.
  • Humana offers a remote opportunity with benefits starting day one, including competitive 401k match and tuition reimbursement.
  • Candidates must demonstrate strong knowledge of claims procedures, contract provisions, and state and federal legislation to make appropriate claim decisions.

Matching Summary

This role involves reviewing all claims identified with potential overpayment opportunities using the EFR Audit Tool.

Salary

Base: $35,900 - $48,200 per year; Bonus/Equity: Not specified; Benefits: Medical, dental, vision, 401k match, PTO, tuition reimbursement

Skills & Requirements

Must-have

  • Fully bilingual in English and Spanish
  • Experience processing medical claims
  • Knowledge of CPT and ICD-9 terminology
  • Proficiency in Microsoft Office applications
  • Ability to work overtime when required

Nice-to-have

  • CIS or CIS Pro experience
  • Strong production and metrics focus
  • Intermediate mathematical skills application

Key Requirements

  • Must be fully bilingual in English and Spanish
  • Proven experience with medical claims processing and adjudication
  • Required CAS system experience
  • Must reside in Puerto Rico
  • Willingness to remain in position for 12 months

Work Rights

Must sit in Puerto Rico

Tailored Resume

Cover Letter