Humana Inc. seeks a Consumer Service Operations Professional 2 to join our team. In this role, you will perform critical analysis by reviewing claims payments, policies, and procedures to identify root causes. You will report to a Manager of Business Intelligence and play a key part in ensuring operational quality.
What You'll Do
- Perform analysis by reviewing claims payments, policies, and procedures to determine root cause for issues.
- Assist with benchmarking, business process analysis, claims processing, testing updates, and claims quality audits.
- Ensure the appropriate identification of root cause through established intake process.
- Perform claim analysis and summarize results with detail at the individual level and determine impacts.
- Identify improvement opportunities based on analysis.
- Act as a claims subject matter expert.
What We're Looking For
- U.S. citizenship (Department of Defense Contract requirement).
- Ability to successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
- Cannot be currently living in Puerto Rico.
- 3 years of experience in a 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 (e.g., DME, DRG, HCPCS, CPT coding, Revenue codes).
Benefits & Compensation
- Salary range: $58,700 - $68,200 per year.
- 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.
Work Mode
This position is remote.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
