Bilingual Consumer Service Operations Rep

Description du poste:

Become a part of our caring community

Join Humana's Infusion Pharmacy team and help patients access the medications and care they need. As a Bilingual Consumer Service Operations Representative, you will partner with providers, patients, and health plans to manage pharmacy referrals and prior authorizations for managed care members. Reporting to the Consumer Service Operations Supervisor, you will review and process health and prescription claims, ensure compliance with payer requirements, including Medicare and Medicaid guidelines, and help guide efficient, accurate service delivery.
You'll serve as a trusted resource for customers and healthcare providers, resolve complex issues, support audits and special projects, and contribute to team success by mentoring and training colleagues. This is an excellent opportunity for someone who enjoys problem-solving, collaborating across teams, and making a meaningful impact on patient care.

Responsibilities:
* Independently follow up on pending orders, including Member Liability and Health Plan authorizations.
* Submit test claim based on prescription request collaborating with the Pharmacy department.
* Work rejections directly with the health insurance company.
* Use telephone or computer systems to obtain additional information and payments.
* Request Prior authorizations.
* Participate in special projects and other assigned tasks.

Use your skills to make an impact

Required Qualifications
* Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance.
* Minimum of 1 year of customer service experience.
* Experience learning and navigating new technology systems.
* Proficient in Microsoft Office Outlook and Word.

Preferred Qualifications
* Pharmacy Technician certification.
* Previous health insurance experience.

Additional Information
* Location: Miramar, FL.
* Workstyle: Hybrid Home, required to be in office one day per week.
* Schedule: The Infusion Pharmacy is open Monday-Friday, 8:00 AM-9:00 PM, Saturday 9:00 AM-6:00 PM, and Sunday, 10:00 AM-7:00 PM. You will follow a rotating schedule, with shifts assigned across the hours of operation and including both weekday and weekend coverage.

Scheduled Weekly Hours
40

Pay RangeThe 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.

$40,000 - $52,300 per year

Description of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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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