[Remote] Pharmacy Contracting Professional 2 at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, PharmacyIndustries

Requirements

Comfortability with troubleshooting and addressing escalated issues or concerns via phone or email as necessary
Strong financial acumen with proficiency in analyzing and interpreting data
Ability to manage multiple tasks and deadlines with attention to detail
Strong verbal and written communication skills
Proficient with Microsoft Excel

Responsibilities

Ensures contract compliance
Performs analysis regarding pharmacy claims
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
Makes decisions regarding own work methods, occasionally in ambiguous situations
Requires minimal direction and receives guidance where needed
Follows established guidelines/procedures

Skills

Key technologies and capabilities for this role

Microsoft Exceldata analysisfinancial acumentroubleshootingverbal communicationwritten communicationpharmacy claimscontract compliance

Questions & Answers

Common questions about this position

What are the required qualifications for this role?

Required qualifications include comfortability with troubleshooting and addressing escalated issues via phone or email, strong financial acumen with proficiency in analyzing and interpreting data, ability to manage multiple tasks and deadlines with attention to detail, and strong verbal and written communication skills.

Is this a remote position, and what are the work-from-home requirements?

This is a work-from-home or hybrid home/office role requiring a dedicated space without interruptions to protect PHI/HIPAA information, internet speeds of at least 25 Mbps download and 10 Mbps upload, and Humana provides telephone equipment.

What preferred qualifications are listed for the Pharmacy Contracting Professional 2 role?

Preferred qualifications include a Bachelor's Degree, Pharmacy Benefit Manager (PBM) experience, experience working inside a pharmacy, process improvement experience, and pharmacy claims experience.

What is the salary or compensation for this position?

This information is not specified in the job description.

What should I know about the hiring process for this role?

The hiring process uses HireVue interviewing technology to assess relevant skills and experience at a convenient time, and applicants may be asked to provide their Social Security Number if not on file.

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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