Job Details

Claims Research amp Resolution Representative 2 Bilingual - English/Spanish Remote

Company name
Humana Inc.

Bridgeport, CT, United States

Employment Type

Bilingual, Customer Service, Call Center

Posted on
Apr 16, 2021

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Job Information


Claims Research & Resolution Representative 2 (Bilingual - English/Spanish) (Remote)





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 interactions and takes action in accordance to it. Escalates unresolved and pending customer inquiries

How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being


The Bilingual Claims Research & Resolution Representative 2 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.

Key Responsibilities

Address incoming telephone, digital, or written inquiries for Puerto Rico providers as a primary task.

Assist with Medicaid incoming calls and inventory on the different intake venues

Escalate complex and unable to resolve inquiries through proper channels

This position reports to the Claims Research and Resolution Supervisor, CCM Service Experience and work closely with all teams in the Customer Service Shared Services department, while potentially collaborating across CCM. This position represents the company by addressing incoming telephone, digital, or written inquiries.

Required Qualifications

High School Diploma or equivalent

Fully Bilingual 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.

Strong knowledge in different computer operating systems

Previous Call Center or Customer Service experience

Schedule: 8:00am-4:30pm EST, Overtime as needed based on business needs

Capacity to maintain confidentiality

High-speed DSL or cable modem internet connection for a home office; a minimum standard speed for optimal performance of 10mb and 1 mb up. A dedicated space with a door that locks preventing ongoing interruptions

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Bachelor's Degree

Prior claims processing experience

Prior Financial Recovery experience

Additional Information

This role is 100% remote, work at home anywhere in the US.

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meeting

Must provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Interview Format

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

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire Text/ Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

​Language Proficiency Testing: Any Humana associate who speaks with a member in a language other than Spanish and/or 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.

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

If you are an Internal Candidate and you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Scheduled Weekly Hours


Company info

Humana Inc.
Website :

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