Senior Provider Reimbursement Professional

Humana

3d • $59,300 - $80,900 • Remote

About The Position

The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and resolution of broad scale, complex and escalated claims for the organization. The Senior Claims Research & Resolution Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors, including collaboration with multiple business areas.

Requirements

• Minimum of 3 years claims research and/or processing experience with CAS
• Minimum of 3 years Mentor experience reviewing Claims processing documents
• Minimum of 3 years CIS/CIS Pro experience
• Minimum of 2 years experience with Medicaid claims
• Minimum of 2 years project leadership experience
• Experience utilizing data analysis tools to review, interpret, and identify trends in claims data, supporting accurate claims adjustment and decision
• Self-provided internet service must meet at least a download speed of 25 Mbps and an upload speed of 10 Mbps.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Nice To Haves

• Experience with Audit Tool
• Experience with EFR system (Enterprise Financial Recovery)

Responsibilities

• Manages claims operations that involve customer contact, investigation, and resolution of broad scale, complex and escalated claims for the organization.
• Analyzes situations or data requiring an in-depth evaluation of variable factors, including collaboration with multiple business areas.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• bonus incentive plan

What This Job Offers

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