[Remote] UM Administration Coordinator at Humana

Kentucky, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must reside in Kentucky or a contiguous border county in Ohio, Indiana, Illinois, Missouri, Tennessee, Virginia, or West Virginia. A minimum of 1 year of administrative or technical support experience is required, along with excellent verbal and written communication skills. Proficiency in MS Office (Word, Excel, Outlook) within a Windows environment and the ability to learn new systems quickly are essential. Preferred qualifications include proficiency with electronic medical record systems, medical terminology, ICD-10 codes, and prior member or customer service telephone experience.

Responsibilities

The UM Administration Coordinator 2 provides non-clinical support for utilization management policies and procedures, ensuring members receive the best and most appropriate treatment or services. This role involves performing varied and moderately complex administrative and operational tasks, making decisions based on policy interpretation, and working within defined parameters with some latitude for prioritization and timing. The coordinator works under minimal direction, follows standard practices with some opportunity for interpretation, and supports the administration of utilization management.

Skills

Administrative Support

Technical Support

MS Office

Word

Excel

Outlook

Windows

Electronic Medical Record

Medical Terminology

ICD-10 Codes

Member Service

Customer Service

Utilization Review

Prior Authorization

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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