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Bilingual Claims Research & Resolution Representative



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Posted on Saturday, February 10, 2024

Become a part of our caring community and help us put health first

Humana is currently seeking a Claims Research & Resolution Representative 2 to work in the Inbound Call Center. Manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization.

Bilingual Claims Research & Resolution Representative 2

  • Customer Service Inbound Call Center role driven by quality, production metrics, and compliance requirements.
  • This inbound call center is comprised of calls/claims/provider associates researching the resolution to a pending call.
  • Works with insurance companies, providers, members, and collection services in the settlement of claims.
  • Incoming telephone, digital, or written inquiries for Puerto Rico providers as a primary task.
  • Assist with all other line of business incoming calls and inventory on the different intake venues
  • Escalate complex and unable to resolve inquiries through proper channels
  • Manage multiple or competing priorities, including use of multiple computer applications simultaneously.

Use your skills to make an impact

Required Qualifications

  • Fully Bilingual in 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 (see Additional Information below)
  • 1 or more years of Call Center or Telephonic customer service experience (in the past 5 years)
  • Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously
  • Capacity to maintain confidentiality

Required Work Schedule:


  • Virtual training for the first 8 -10 weeks following start from 8:00 AM – 4:30 PM EST, Monday - Friday. Attendance is vital for your success; no time off will be allowed during training.
  • The initial 120 days of employment as a Claims Research & Resolution Representative 2 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.
  • 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 eighteen (18) months before applying to other Humana opportunities.

Work Hours:

  • Following training, must be able to work a schedule of 8:00 AM to - 4:30 PM EST. Overtime may be required, based on business needs.

Preferred Qualifications

  • Claims processing experience
  • Financial recovery experience

Additional Information

Please be sure to include your resume with your application!

As part of our hiring process for this opportunity, we will be using an 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!

Language Proficiency Testing: 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.

Work From Home:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office employees 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

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

Scheduled Weekly Hours


Pay Range

The 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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$34,500 - $47,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, 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 us

Humana 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 Employer

It 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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

This job is no longer accepting applications

See open jobs at Humana.