[Remote] Senior Provider Payment Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Three or more years work experience reading and interpreting claims within a managed care/health care environment
Familiarity with Medicaid contracts, claims, and/or process flows
Skilled in data and/or situational analysis
Comprehensive 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
Passionate about contributing to an organization focused on continuously improving consumer experiences
Bachelor’s Degree
Experience leading people, projects, and/or processes
Experience in Financial Recovery
Experience using the following systems: CAS, MTV, CISpro and CIS
Knowledge of Microsoft Office Programs Access and Project
Experience in a fast paced, metric driven operational setting
Bilingual in Spanish and English
Minimum download speed of 25 Mbps and upload speed of 10 Mbps internet connection

Responsibilities

Uses technology and data mining to detect anomalies in data to identify and collect overpayment of claims
Contributes to the investigations of fraud, waste, and financial recovery
Contributes to overall cost reduction, by increasing the accuracy of provider contract payments in payer systems, and by ensuring correct claims payment
Begins to influence department’s strategy
Makes decisions on moderately complex to complex issues regarding technical approach for project components
Work is performed without direction
Exercises considerable latitude in determining objectives and approaches to assignments

Skills

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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