Senior Business Systems Analysis Professional - Payment Integrity

Kentucky, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates should possess previous knowledge or experience with payment integrity and/or subrogation. A working knowledge of ad-hoc query tools and data repositories like SQL or TOAD is required, along with previous project leadership experience and knowledge of the Systems Development Life Cycle. Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, Access, PowerPoint, and Visio, is also necessary.

Responsibilities

The Senior Business Systems Analysis Professional will perform analysis of business, process, and user needs, document requirements, conduct cost/benefit analysis, and translate these into system requirement specifications. This role involves analyzing moderately complex to complex issues requiring in-depth evaluation of variable factors. The professional will manage project work for system migration, lead the development of a business case for correspondence modernization, and develop processes to analyze COB MSP Part C&D data to identify other liable parties. They will also oversee the development of a repository for COB MSP data to ensure CMS compliance and influence department strategy by performing cost/benefit analysis of subrogation's future organizational model.

Skills

Business Systems Analysis

Requirements Documentation

Cost-Benefit Analysis

System Requirement Specifications

Subrogation

Payment Integrity

Third Party Liabilities

NLP

RPA

CMS

COB MSP Part C&D data

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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