Code Edit Professional 2

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates must be proficient in managing diverse priorities and comfortable navigating dynamic environments. Strong problem-solving abilities, analytical thinking, and proficiency in Microsoft Office programs (Word, SharePoint, Excel) are essential. Excellent verbal and written communication skills, attention to detail, and the ability to work independently and in a team with minimal supervision are required. Prior experience with code edit vendor tools such as Rialtic, ClaimsXten, Cotiviti, or Optum CES, along with experience in claims administration and payment integrity, is strongly preferred.

Responsibilities

The Payment Integrity Professional 2 will utilize vendor platforms and claims processing systems to collaborate with internal and external stakeholders, supporting claims code editing pre and post-implementation. Key responsibilities include fostering relationships with vendors and internal teams, supporting new code edit reviews, testing, implementation, and maintenance. The role also involves managing and resolving stakeholder inquiries and driving process improvements to ensure the successful run of business and contribute to claims cost reduction.

Skills

Claims processing

Data analysis

Stakeholder management

Process improvement

Problem-solving

Prioritization

Adaptability

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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