Senior Business Systems Analysis Professional - Payment Integrity

About the Role

Become a part of our caring community and help us put health first. The Senior Business Systems Analysis Professional performs analysis of business, process and user needs, documentation of requirements, cost/benefit analysis and translation into proper system requirement specifications.

The Senior Business Systems Analysis Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Key Responsibilities & Projects

This role requires in-depth knowledge of subrogation/payment integrity methodologies regarding third party liabilities and procedures, as well as the varying analytical methodologies, business systems and procedures of each of our five supporting vendors. The role also requires technical experience necessary to collaborate with IT partners and guide strategies that implement various new tools driven by AI, NLP, RPA, etc.

Subrogation is a unique & complex practice, and near-term the candidate’s background and experience will be necessary to assist the team with the technical approach for the following projects:

• Manage the significant amount of project work identified to support a system migration
• Assume lead role in working with the Enterprise Operations Enablement (EOE) team our Insurance AI Lean Business Case for Correspondence Modernization
• Development of a process to make use of COB MSP Part C&D data provided by CMS to payers to properly analyze and investigate requirements to determine other liable parties due to Medicare set aside settlement arrangements for both Part C and Part D
• Oversee development of a repository of the COB MSP data to ensure compliance with existing and anticipated CMS requirements
• Influence department’s strategy and perform cost/benefit analysis of subrogation’s future organization model as we define the selection criteria for an RFI

Use your skills to make an impact.

Required Qualifications

• Previous knowledge or experience with payment integrity and/or subrogation experience
• Working knowledge of ad-hoc query tools and data repositories that support data extraction and manipulation such as SQL or TOAD
• Previous project leadership experience
• Knowledge of Systems Development Life Cycle
• Experience in problem analysis and process
• Comprehensive knowledge of all Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio

Work-At-Home Requirements

• At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Advanced Degree
• Minimum 5 years of payment integrity and/or previous subrogation experience
• Previous healthcare experience
• Six Sigma certification
• PMP certification
• Demonstrated experience with process documentation and re-engineering

Additional Information

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While