Senior Provider Reimbursement Professional

Become a part of our caring community.

About the role

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. 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.

Responsibilities

• Manage claims operations involving customer contact, investigation, and resolution of complex and escalated claims.
• Collaborate with multiple business areas to analyze and resolve moderately complex to complex claims issues.
• Utilize data analysis tools to review, interpret, and identify trends in claims data to support accurate claims adjustment and decision-making.

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.

Preferred Qualifications

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

Work at Home Requirements

• Self-provided internet service must meet the following criteria: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL connection suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled Weekly Hours: 40

Pay

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

$59,300 - $80,900 per year

This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.