Humana Inc. is hiring a Director - Payment Integrity Audit Operations to oversee the use of technology and data mining to detect anomalies, identify overpayments, and contribute to financial recovery. This role is critical for increasing the accuracy of provider payments, implementing strategic plans, and driving cost reduction across our healthcare operations.
What You'll Do
- Use technology and data mining to detect anomalies in data to identify and collect overpayment of claims.
- Contribute to the investigations of fraud, waste, and financial recovery.
- Contribute to overall cost reduction by increasing the accuracy of provider contract payments and ensuring correct claims payment.
- Make decisions related to the implementation of new or updated programs or large-scale projects.
- Implement strategic plans, drive goals and objectives, and improve performance.
- Provide input into functions strategy.
What We're Looking For
- Minimum 5 years of progressive people management experience.
- Previous experience with healthcare operations.
- Previous experience in the medical claims space.
- Experience leading projects and processes.
- Experienced facilitating, consulting, and delivering complex concepts.
- Progressive experience in onshore/offshore contracting space for a health solutions industry.
- Able to determine the needed approach, resources, and goals to meet business objectives.
- Demonstrated experience with cross departmental collaboration.
- Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel.
- Ability to handle multiple priorities.
- Capacity to maintain confidentiality.
- Excellent communication skills both written and verbal.
- Proficiency in analyzing and interpreting financial trends.
- Strong collaboration skills.
Nice to Have
- Advanced Degree.
- Experience in Financial Recovery.
- Accounting/CPA experience.
- Experience with Payment Integrity.
- Experience with the CAS and/or MTV systems.
- Knowledge of Microsoft Office Programs Access and Project.
- Project Management Professional (PMP) Certification.
- SAFe Agile experience.
Technical Stack
- Microsoft Office: Word, PowerPoint, Excel, Access, Project
- CAS and/or MTV systems
Benefits & Compensation
- Compensation: $138,900 - $191,000 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 is a remote position open to candidates residing in California, Illinois, Montana, or South Dakota.
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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.
