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Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
Description The Outbound Contacts Representative 3 represents the company by making outbound contacts to members and/or providers regarding a variety of issues. The Outbound Contacts Representative 3 performs advanced administrative/operational/customer support ..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Job Information Humana Grievances & Appeals Representative 3 (Fully Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Grievances & Appeals Representative 3 manages client medical denials by ..
... Research & Resolution Representative 2 (Bilingual - English/Spanish) (Remote) in San ... Juan Puerto Rico Description The Bilingual Claims Research and Resolution Representative ... perks for well-being Responsibilities The..
Description Do you enjoy helping those in need? Do you love researching, analyzing medical documents to determine if something was missed? Have you ever considered yourself a detective for medical claims ..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g. CPT) to patient records. The Medical Coding Auditor ..
Job Information Humana Grievances & Appeals Representative 3 (Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Grievances & Appeals Representative 3 manages client medical denials by conducting ..
Description The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced ..
Description The Product Manager 2 Conceives of, develops, delivers, and manages products for customer use. The Product Manager 2 work assignments are varied and frequently require interpretation and independent determination of ..
Job Information Humana Outbound Contact Representative 3 (FULLY Bilingual English/Spanish) San Juan, Puerto Rico in San Juan Puerto Rico Description The Outbound Contacts Representative 3 represents the company by making outbound ..
... Inbound Contacts Representative 2 (Fully Bilingual in English/Spanish) in San Juan ... be interested in the health insurance industry, Medicare Care Advantage industry, ... performed for English and or..
Job Information Humana Senior Business Support Professional (Fully Bilingual English/Spanish) San Juan, PR in San Juan Puerto Rico Description The Senior Business Support Professional follows established procedures and guidelines to provide ..
Description The Supervisor, Consumer Service Operations is responsible for the daily activities across multiple service functions area. The Supervisor, Consumer Service Operations works within thorough, prescribed guidelines and procedures; uses independent ..
Description The Bilingual Claims Research and Resolution Representative 2 address customer needs which may include complex financial recovery questions, and resolving issues. Records details of inquiries, comments or complaints, transactions or ..
... an organization that provides health insurance. The Subrogation Representative 3 performs ... interacts with attorneys and third-party insurance professionals to explore where there ... for members who have other..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
Job Information Humana Call Quality Professional 1 (Bilingual English/Spanish) in San Juan Puerto Rico Description The Call Quality Professional 1 monitors and evaluates the quality of inbound and/or outbound customer service ..
Description The Project Manager 2 manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Manager 2 work assignments ..
Description The Senior Internal Auditor develops, plans and executes internal audits to provide assurance for Puerto Rico's accounting records and the operational activities of Puerto Rico to ensure compliance with the ..
Description The Wellness Coach 2 supports health promotion and disease prevention and care management services. The Wellness Coach 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Supervisor, Inbound Contacts represents the company by addressing incoming telephone, digital, or written inquiries. The Supervisor, Inbound Contacts works within thorough, prescribed guidelines and procedures; uses independent judgment requiring ..
