Payment Integrity Professional 2

Profile

Description

The Claims Cost Management team audits claims submitted by providers. We look at all aspects of the claim to find overpayments and our savings forecasts become a crucial piece of Humana's financial goals and bidding process. As a Provider Payment Integrity Professional 2 on the Claims Cost Management team, you will provide support through data analytics and testing for database projects . You will complete analyses and prepare documentation materials while interacting and building partnerships with Humana's internal Clinical Auditing, Finance, and Information Technology teams. Most directly, this role will impact how the Claims Cost Management group builds financial projections and analyzes savings found through clinical claims audits.

Responsibilities

This role will take on many tasks, including the following:

Test and validate financial models to help better project financial goals for the clinical claims auditing programs.

Gather business logic and provide feedback for dashboards and data models.

Manage special projects and report builds - monitoring progression, reviewing assumptions and tracking changes.

Collaborate with finance stakeholders and operational leaders to gather input and assumptions.

Build documentation for data processes and forecasting models.

Pioneering analytics by using new and existing reporting.

COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF - TUITION ASSISTANCE PROGRAMS - STELLAR WELLNESS/REWARDS PROGRAM

Role Essentials

Bachelor's Degree

Comprehensive knowledge of Microsoft Office Suite

SQL Database experience

2-3 years' experience in an accounting or finance role

Project initiative background - ability to push to make things happen, meeting deadlines, bringing individuals together, along with ability to challenge when necessary.

Excellent communication skills, both written and verbal

Excellent presentation skills

Preferred Qualifications

Power BI and database proficiency

2-3 years' experience in a data analytics

Work at Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information - How we Value You

Health/Vision/Dental Benefits Effective day one

Competitive pay/salary ranges

PTO

VTO day

Associate Incentive Plan

401K Match- Immediate company match of 125 percent on the first 6 percent of your pretax 401(k) or Roth 401(k) contributions.

Well-being program

Tuition Reimbursement

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com