Company Profile

Become a part of our caring community and help us put health firstThe Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Where you Come In The Claims Review Representative partners with ...

Become a part of our caring community and help us put health firstThe Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference ...

Become a part of our caring community and help us put health firstJoin Humana's dynamic Puerto Rico team as a Claims Research & Resolution Representative and make a meaningful impact every day! In this vital role, you'll be at the heart of our claims operations-connecting with providers and members to resolve and settle claims that shape the health industry. You'll leverage your expertise and independent judgment to investigate cases, approve settlements, and navigate complex administrative ...

Become a part of our caring community and help us put health firstThe Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Initial and Appeals/Disputes level. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, ...