Job Overview
Location
Remote Puerto Rico
Job Type
Full-time
Category
Product Management
Date Posted
June 18, 2026
Full Job Description
đź“‹ Description
- • Work with healthcare providers, members, and third-party collection services to resolve complex medical claims accurately and in a timely manner.
- • Investigate claim discrepancies by verifying documentation and ensuring compliance with internal policies and federal regulatory standards.
- • Collaborate with claims, call center, and provider associates to research and resolve pending claims issues using independent judgment and organizational knowledge.
- • Apply advanced decision-making skills to determine appropriate strategies, workflows, and methods for managing administrative tasks and complex claim resolution scenarios.
- • Operate with a high degree of autonomy, leveraging experience to resolve member and provider inquiries without constant supervision.
- • Complete an 8-week mandatory training program Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time Zone (EST), with no time off permitted except for Humana-observed holidays.
- • After training, maintain a consistent Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time Zone (EST) work schedule.
- • Adhere to a 90-day probationary period during which no time off is permitted.
- • Remain in this role for a minimum of 18 months before applying for other positions within Humana.
- • Work from a dedicated, interruption-free home space that ensures the confidentiality and security of member PHI in compliance with HIPAA regulations.
- • Use a hard-wired internet connection with a minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, satellite, cellular, and microwave connections are prohibited.
- • Utilize Humana-provided telephone equipment for business communications.
- • Participate in a video prescreen assessment via HireVue as part of the hiring process.
- • Submit a resume in English in PDF or Word format with your application.
- • Be prepared for occasional travel to Humana offices for training or required meetings.
- • Work a scheduled 40 hours per week with no flexibility in core hours during training or the first 90 days of employment.
🎯 Requirements
- • Must reside in Puerto Rico
- • 1+ years of claims or customer service experience
- • Must be able to speak, read, and write in English without limitations or assistance
- • Capacity to maintain confidentiality of member information
- • Ability to commit to 8 weeks of full-time, uninterrupted training (Monday–Friday, 8 a.m.–5 p.m. EST)
- • Must use a hard-wired internet connection with minimum 25 Mbps download and 10 Mbps upload speeds
🏖️ Benefits
- • Medical, dental, and vision benefits
- • 401(k) retirement savings plan
- • Paid time off, company and personal holidays, volunteer time off, and paid parental and caregiver leave
- • Short-term and long-term disability coverage
- • Life insurance
- • Humana-provided telephone equipment for remote work
Skills & Technologies
See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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