Bilingual Claims Review Representative

Humana

Claims Review Representative at Humana processing and adjudicating medical claims. Requires bilingualism in Spanish and English with significant healthcare processing experience.

Posted 7/13/2026full-timeRemote • 🇵🇷 Puerto RicoJunior💰 $35,800 - $48,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing and adjudicating medical claims, with a strong understanding of CPT, ICD9, and ICD10 codes. Fully bilingual in Spanish and English, capable of effectively communicating and interpreting provider information.

Highest-signal resume keywords

Bilingual In Spanish/EnglishMedical Claims ProcessingCPT, ICD9, ICD10 KnowledgeMicrosoft Office ProficiencyDiscretion And Judgment

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Claims AdjudicationCPT CodingICD9 CodingICD10 Coding

Soft Skills

DiscretionJudgmentPrioritization

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Outlook

About the role

Key responsibilities & impact

partners with professional staff on pre-screening review by applying guidance
makes appropriate decision which may include interpretation of provider information or data
focuses on methods, tactics and processes for completing administrative tasks/projects
regularly exercises discretion and judgment in prioritizing requests and interpreting procedures

Requirements

What you’ll need

Fully Bilingual in Spanish/English
Minimum of 1 year of strong and proven experience with processing and adjudicating medical claims
Knowledge with CPT, ICD9, and ICD10 terminology/codes
Proficiency in Microsoft Office applications including Word, Excel and Outlook

Benefits

Comp & perks

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability insurance
life insurance