Payment Integrity Professional

About the Role

Become a part of our caring community and help us put health first. The Payment Integrity Professional 2 uses technology and data mining to detect anomalies in data, identifying and collecting overpayments of claims. You will contribute to the investigations of fraud, waste, and financial recovery.

Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action. You will contribute to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and by ensuring correct claims payment. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding your own work methods, occasionally in ambiguous situations, and will require minimal direction, receiving guidance where needed. You will follow established guidelines and procedures.

Use your skills to make an impact!

Work Style

• WORK STYLE: Remote/Work at Home.
• Team meetings might require very occasional travel to Louisville.
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Work Hours

• Typical business hours, Monday-Friday, 5 days/week, 8 hours/day, typically in the employee's time zone.
• Some flexibility might be possible, depending on business needs.

Required Qualifications

• Working knowledge of Microsoft Office Programs: Word, PowerPoint, and Excel.
• Strong attention to detail.
• Can work independently and determine appropriate courses of action.
• Ability to handle multiple priorities.
• Capacity to maintain confidentiality.
• Excellent communication skills both written and verbal.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

• HIGHLY PREFERRED: A minimum of one year of work experience reading and interpreting claims.
• HIGHLY PREFERRED: Experience using the following systems: CAS, MTV, CISpro, and CIS.
• Bachelor's Degree.
• Experience leading people, projects, and/or processes.
• Experience in Financial Recovery.
• Knowledge of Microsoft Office Programs: Access and Project.
• Experience in a fast-paced, metric-driven operational setting.

Additional Information

Work at Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue (formerly Modern Hire), a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.

• If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
• If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes.

Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

#ThriveTogether #WorkAtHome