Claims Process amp Policy Professional 2

Profile

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 metrics for early identification of problems and areas for process improvement. Identifies new areas for reporting and early identification of problems.

KEY ACCOUNTABILITIES

Provide team members with data analytics that provide insights into claims payments based on policy

Collect and analyze multi-faceted data using advanced methodologies and tools

Use the data you have generated to develop improvements, assisting in the presentation and implementation of your recommendations and solutions

Develop and maintain KPIs

Creates reporting that enables improvement and measuring

Root cause reporting for claims issues

Oversight of daily reporting

Our Department of Defense Contract requires U.S. citizenship for this position .

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives .

Required Qualifications

Our Department of Defense Contract requires U.S. citizenship for this position

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Prior experience working within the health service industry and/or service operations

Strong attention to detail

Prior data analysis experience

Ability to work independently and with a team

Demonstrated ability to meet deadlines

Comprehensive knowledge of Microsoft Excel, and PowerPoint

Knowledge of creating access database queries

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Bachelor's Degree (in business, health care or information systems area preferred)

2 years TRICARE or Medicare Experience

Working knowledge with SQL

Six Sigma certification

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire Text to enhance our hiring and decision-making ability. Modern Hire Text 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.

If you are selected for a first round interview, you will receive a correspondence inviting you to participate in a Modern Hire Text interview. In this interview, you review a set of interview questions over your phone and you will provide text responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your text message interview 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