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Job Information Humana Healthcare Data Analyst in Louisville Kentucky Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. ..
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 claim settlements both for ..
Description The Health Information Management Professional 2 ensures data integrity for claims errors. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Health Information Management Professional 2 ensures data integrity for claim errors while maintaining ongoing research and special projects. The Health Information Management Professional 2 work assignments are varied and ..
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 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 ..
Description The Medical Director's primary responsibility is the review of medical authorizations or claims to determine the medical necessity of a given service or level of care. The Medical Director's work ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
... Humana Lead Product Manager - Healthcare API in Louisville Kentucky Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..
Description The mission of the Physician Performance Insights team is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain ..
Description Humana Healthy Horizons in Indiana is seeking a Provider Services Advisor (Market Development Advisor) who will be responsible for the strategic and tactical support of the Provider Services team. They ..
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 Claims Quality Audit Professional 1 works with the Resolution Quality Audit leadership team to support efficiency and day to day operations. Requires in-depth knowledge of Microsoft products Excel, ..
Description The Health Information Management Professional 2 ensures data integrity for claims received. The Health Information Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of ..
Description The Associate Director, Clinical Pharmacy monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, ..
... mission of supporting the TRICARE healthcare program for our nation's military? ... years of experience in a healthcare or managed care setting 3 ... 3 years of experience in..
Job Information Humana Senior Consumer Service Operations Analyst-Remote KY, IN or WI in Louisville Kentucky Description The Senior Consumer Service Operations Professional is responsible for the daily activities across multiple service ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Louisville Kentucky Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..
Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments ..
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 ..
