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Description Humana has a new Claims Research & Resolution Supervisor opening for those in the Green Bay, WI and Louisville, KY areas. The Supervisor manages claims operations that involve customer contact, ..
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Description The Care Management Support Assistant 3 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal ..
Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of ..
u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u003c/strongu003eu003c/pu003enu003cpu003eThe Clinical Supervisor (RN) will oversee a team of 20 to 30 remote Medical Review Nurseu0026nbsp; Analysts (NA) that complete Targeted Probe and Educate (TPE) work for our Medicare ..
Description The Actuary, Pricing MA-PD is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new ..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
Description As Lead Actuary of the Risk Predictive Models team, you have an opportunity to both learn more about predictive analytics and machine learning and to see it become very real ..
Description Responsibilities The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided ..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Description Responsibilities This role within the Autism Care Demonstration (ACD) Team, will work closely with Care Management leaders and Subject Matter Experts in the areas of Case Management, Utilization Management and ..
Description The Pharmacy Claims Lead operationalizes and monitors Coordination of Benefits (COB) and subrogation claim processing logic and processes. Exercises independent judgment and decision making on managing staff, complex issues regarding ..
Description Responsibilities The Consumer Service Operations Professional 2 evaluates claims oversight performance metrics by interfacing with the sub-contractor to gather and track associated reporting. The Consumer Service Operations Professional 2 evaluates ..
Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description This role has responsibility for the oversight and monitoring of the Autism Care Demonstration (ACD) team performance to ensure compliance with contract and complex ACD policy requirements as defined by ..
Description Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies. ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u0026nbsp;u003c/strongu003eu003c/pu003enu003cpu003eThe Prior Authorization Nurse Analyst is a work from home position that will assist in reviewing medical documentation for prior authorization requests submitted.u003c/pu003enu003cpu003eu003cstrongu003eIn this role you will:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003ePerform review of ..
... moderate to substantial. Responsibilities Humana Healthcare Research (HHR) needs your analytical ... tell a compelling story about healthcare today. Through the design and ... with meaningful real-life insights about..
Description The Clinical Pharmacy Advisor lead, overseeing Humana Pharmacy and Medical Trend, is a dynamic role within Humana. We are seeking a positive and proactive individual to contribute to a high ..
Description The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for claims reserve valuation, financial forecasting, and strategic and operational decisions within ..
