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DescriptionThe Senior Payment Integrity Professional uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesThe Senior Payment Integrity Professional contributes to overall cost reduction, by increasing the accuracy and efficiency of recovering benefits paid in error, 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, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Foster strong working relationships with peers, vendors and internal business process owners to create viable solutions and processes that meet business needs (subrogation, pre-pay, post-pay, financial recovery, FP&A)
Partner with subrogation vendor management team and vendor relationship owners to automate and enhance processes
Drive creation of and maintain vendor and department dashboards, inventory, performance & financial metrics, and adhoc reporting
Assist with monitoring and analyzing vendor and business performance and trends
Monitor established data, financial and reporting processes and lead projects with supporting teams to drive strategy
Required Qualifications
5 years of Data Analytics experience
5 or more years work experience reading and interpreting claims
Comprehensive knowledge of Microsoft Office programs Excel, Access and PowerPoint
Demonstrated experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
Excellent ability to solve problems that require analytical reasoning, creative thinking, comfort with numbers, and ability to untangle complex issues
Strong attention to detail
Skilled in data and/or situational analysis
Can work independently and determine appropriate courses of action
Excellent communication skills both written and verbal, ability to summarize and be concise
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
High emotional intelligence and interpersonal skills with all levels of leadership
Takes initiative and is eager to propose solutions
Demonstrated capacity to manage competing priorities
Ability to travel 10%
Preferred Qualifications
Bachelor's Degree
Experience leading people, projects, and/or processes
Sound understanding of Claims Cost Management
Healthcare Subrogation background
Experience using the following systems: MOAT, CAS, MTV, CRM, Qlikview, SQL
Experience in a fast paced, metric driven operational setting
Vendor management or oversight experience
Expertise in data mining, forecasting, simulation, and/or predictive modeling
Experience with tools such as Power BI for creating data visualizations
Additional Information
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
Scheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.