Consumer Service Operations Professional 2

Humana • Carapichaima, NE

3d • Remote

About The Position

Become a part of our caring community and help us put health first You will perform analysis by reviewing claims payments, policies, procedures and determine root cause for issues. You will need a strong knowledge of claims and how to apply policy to claims processing accuracy. You may assist with benchmarking, business process analysis, claims processing, testing updates and claims quality audits. You will report to a Manager of Business Intelligence. Accountabilities - Ensure the appropriate identification of root cause through established intake process. Performs claim analysis and summarize results with detail at the individual level and determine impacts. Identifies improvement opportunities based on analysis. Acts as a claims subject matter expert. Use your skills to make an impact

Requirements

• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 3 years of experience in managed care environment
• 4 years of claims experience processing/adjudicating professional, inpatient, and outpatient claims
• Experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement
• 2 years of customer service experience
• Familiarity with reimbursement terminology (ie DME, DRG, HCPCS, CPT coding, Revenue codes, etc)
• 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

Responsibilities

• Ensure the appropriate identification of root cause through established intake process.
• Performs claim analysis and summarize results with detail at the individual level and determine impacts.
• Identifies improvement opportunities based on analysis.
• Acts as a claims subject matter expert.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed