[Hiring] Consumer Service Operations Professional 2 @Humana

Role Description

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.

• 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.

Qualifications

• U.S. citizenship required due to Department of Defense Contract.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
• 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).

Requirements

• 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.
• Occasional travel to Humana's offices for training or meetings may be required.

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$58,700 - $68,200 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

• 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.

Equal Opportunity Employer

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.