Senior Medical/Financial Risk Clinical Professional

Profile

Job Information

Humana

Senior Medical/Financial Risk Clinical Professional

in

Albuquerque

New Mexico

Description

The Senior Medical/Financial Risk Clinical Professional is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Senior Medical/Financial Risk Clinical Professional work assignments involve review of claims data providing reports that includes information about the member's diagnosis, services received, chronic condition management or case management participation, and approximate cost of any recurring services.

Responsibilities

The Senior Medical/Financial Risk Clinical Professional provide stop loss carriers and Humana Underwriters or Internal/External Customer, with detail clinical reports that correspond with the stop loss contract.

Provides supporting documentation and information to stop loss carriers.

Utilizes knowledge and experience to enhance processes and provide guidance to internal and external customers.

Maintains a balance between risk mitigation and efficiency.

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.

Required Qualifications

Bachelor's degree or two or more years of technical or clinical medical claims experience

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Proficiency in Microsoft Office Word, Excel, Outlook, and Power-Point

Work At Home Requirements: Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work. 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.

COVID Requirements

: For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including booster or commit to testing protocols

*OR  *

Provide proof of applicable exemption including any required supporting documentation

​​ Medical, religious, state and remote-only work exemptions are available.

Preferred Qualifications

Licensed RN or LPN

Additional Requirements

Hours:

Flexible hours, but mainly between 8 am to 5 pm Eastern time.

Modern Hire:

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

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