Medicare Secondary Payer & Coordination of Benefits (MSP&CB) Specialist ENTRY Level Job- Bilingual
San Juan, Puerto Rico,US
hace 16 días

Medicare Secondary Payer & Coordination of Benefits (MSP&CB) Specialist ENTRY Level Job- Bilingual - San Juan, Puerto Rico : 192083

Primary Location

US-Puerto Rico-San JuanWork Environment Type : Office


NoRole : Coordination of Benefits / Medicare Secondary Payer Investigations SpecialistAssignment : PNOLocation : San Juan, Puerto Rico Assignment Capsule This role will include investigating members who may have an another insurance plan in addition to their Humanan plan, that needs to be properly coordinated.

This will require making calls to other insurance carriers to validate the information, determining primary, updating Humana systems and the Center for Medicaid and Medicare (CMS) systems.

These updates allow for claims to be paid correctly and for Medicare membership ensures the correct premium is received from CMS.

Claims will need review on occasion to ensure they were paid correctly based on the primacy updates that were made. In this role you will :

  • Build lasting relationship with Humana’s internal and external customers
  • Educate customers, providers and employers about Humana’s products and services
  • Role Essentials

  • Strong written and verbal communication
  • Professional demeanor
  • High level of emotional intelligence
  • Analytical and problem solving skills
  • Bilingual English / Spanish. Candidate selected will not be communicating in Englis with Members. Intermediate / Advance level Role Desirables
  • Associate or Bachelor’s Degree
  • Working knowledge of Claims Cost Management
  • Experience in a role requiring problem solving skills
  • Proven initiative mentoring others
  • Working knowledge of Coordination of Benefits (COB)
  • Working knowledge of Medicare Secondary Payer (MSP)
  • Working knowledge CAS
  • Experience with CCP and / or CRM
  • Medical claims processing and interpretation experience
  • Reporting Relationship

    You will report to a FLL. Additional information Mon-Fri 7 : 30 4 : 30, OT depending on business needs (weekdays and weekends.

    Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-

    being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

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