Senior Pharmacy Claims Professional - Financial Recovery - Humana
Dover, DE
About the Job
Become a part of our caring community and help us put health first
Are you ready to take your pharmacy career to the next level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional, you will play a pivotal role in resolving outstanding balances related to claim reversals, all while leading process improvements and influencing departmental strategies. This is your chance to own your work, solve moderately complex to highly technical issues, and make decisions with autonomy.
With your exceptional negotiation skills, ability to directly communicate with providers and internal business partners, and strong attention to detail, you'll thrive in our fast-paced, dynamic environment. If you excel at managing multiple projects, staying organized, and adapting to change, this is the perfect opportunity for you to drive your career forward. Join us and take the lead on building solutions that make a difference!
The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding pharmacies' outstanding balances related to the claim reversals. Plays an active role in process improvement and building new processes.
+ 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.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree.
+ 5 years of data analysis & problem-solving regarding process and workflow concepts.
+ Comprehensive knowledge of all Microsoft Office applications, including Access, Excel, Word, and PowerPoint.
+ Effective negotiation skills.Strong attention to detail.
+ Ability to work in a fast paced, dynamic and changing environment while managing multiple projects simultaneously.
+ Strong organizational and time management skills.
+ Quick learner and ability to work independently with minimum supervision.
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
+ Excellent verbal and written communication skills.
Preferred Qualifications
+ Previous experience in health insurance pharmacy business.
+ Knowledge of SQL.
+ Knowledge of Power BI.
_Additional Information_ _'You must be authorized to work in the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role.'_ _Work at Home Guidance_ _To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:_
+ _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_
_Social Security Task:_ _Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from_ _Humana@myworkday.com_ _with instructions to add the information into the application at Humana's secure website._ _HireVue Statement_ _As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule._
Scheduled Weekly Hours
40
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.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Are you ready to take your pharmacy career to the next level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional, you will play a pivotal role in resolving outstanding balances related to claim reversals, all while leading process improvements and influencing departmental strategies. This is your chance to own your work, solve moderately complex to highly technical issues, and make decisions with autonomy.
With your exceptional negotiation skills, ability to directly communicate with providers and internal business partners, and strong attention to detail, you'll thrive in our fast-paced, dynamic environment. If you excel at managing multiple projects, staying organized, and adapting to change, this is the perfect opportunity for you to drive your career forward. Join us and take the lead on building solutions that make a difference!
The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding pharmacies' outstanding balances related to the claim reversals. Plays an active role in process improvement and building new processes.
+ 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.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree.
+ 5 years of data analysis & problem-solving regarding process and workflow concepts.
+ Comprehensive knowledge of all Microsoft Office applications, including Access, Excel, Word, and PowerPoint.
+ Effective negotiation skills.Strong attention to detail.
+ Ability to work in a fast paced, dynamic and changing environment while managing multiple projects simultaneously.
+ Strong organizational and time management skills.
+ Quick learner and ability to work independently with minimum supervision.
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
+ Excellent verbal and written communication skills.
Preferred Qualifications
+ Previous experience in health insurance pharmacy business.
+ Knowledge of SQL.
+ Knowledge of Power BI.
_Additional Information_ _'You must be authorized to work in the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role.'_ _Work at Home Guidance_ _To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:_
+ _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_
_Social Security Task:_ _Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from_ _Humana@myworkday.com_ _with instructions to add the information into the application at Humana's secure website._ _HireVue Statement_ _As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule._
Scheduled Weekly Hours
40
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.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana