Provider Resolution Representative

Other Jobs To Apply

No other job posts for this day.

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

The Correspondence Representative 2 performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. Updates, maintains, and reviews fee scheduling and pricing structures. Ensure contracted rates and reimbursement policies are priced and applied accurately.

The Correspondence Representative 2 is responsible for:

  • Making reimbursement policy and process recommendations and ensures compliance with government regulations.

  • Analyzing provider reimbursement patterns and trends.

  • Making decisions that are typically focused on methods, tactics and processes for completing administrative tasks/projects.

  • Regularly exercising discretion and judgment in prioritizing requests, interpreting and adapting procedures, processes and techniques.

  • Working under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.


Use your skills to make an impact

Required Qualifications:

  • Must reside within 1 hour from our Corporate Building in San Juan, Puerto Rico

  • 1+ years of strong technical skills with the ability to work across multiple software systems and monitors including Outlook, Teams

  • 2+ years of Customer Service and/or administrative experience

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

  • Proficiency with Microsoft office applications (Word, Excel, Outlook)

Preferred Qualifications

  • High School Diploma or GED

  • CAS experience

Required Work Schedule:

Training:

  • This position is scheduled to start on December 15th, 2025, Virtual training starts day one of employment and will run for 2-4 weeks with a schedule of 8:00 AM – 4:30 PM Eastern Monday - Friday.

  • You must be on time, in a quiet environment, dressed appropriately, with your camera ON during training and for other meetings required by leadership.

Work Schedule Following Training:

  • Following training,associates are required to have flexibility to work ANY 8-hour shift between the hours of 6:00 AM – 6:30 PM Eastern time, Monday - Friday.Some weekends and overtime may be required, based on company needs.

  • The initial 120 days of employment 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.

  • The department has a strict attendance policy. Time off is not permitted during the first 90 days and is discouraged during the 120-day appraisal period.

  • 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 twelve (12) months before applying to other Humana opportunities.

Remote Work at Home Requirements

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

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended.

  • Associates in this role are required to be hard-wired to their internet connection. Wireless, satellite, cellular and microwave connections are not permitted.

  • Humana will provide Home or Hybrid Home/Office associates 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.

Additional Information

**PLEASE MAKE SURE YOU ATTACH YOUR RESUME IN ENGLISH TO YOUR APPLICATION (PDF OR WORD FORMAT) **

  • 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.

Interview Process

As part of our hiring process for this opportunity, we will be using technology called HireVue to enhance our hiring and decision-making ability. HireVue 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. 

Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete 10 to 15 prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.

Assessment: If you are selected to move forward, you will receive an email to complete the Virtual Job Experience (VJE). This is an online activity where you will learn more about Customer Care jobs at Humana, try out some of the most common job tasks, and tell us more about yourself. Most people complete the VJE in approximately 30 minutes. To complete it, you will need a smart phone, computer or tablet with internet access, and speakers/headphones. We do not make job offers to candidates that do not complete the VJE.

Video Prescreen: If you are successful with the VJE, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.

Interviews: Some candidates will be invited to interview. If so, the recruiter will reach out to schedule.

Offers: Finalists from the interview will be contacted by a recruiter to discuss an offer for the job

NOTE: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$30,000 - $39,200 per year

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...