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Description The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer ..
Description The Inbound Contacts Representative 1 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 1 performs administrative/operational/customer support/computational tasks. Typically works within a framework ..
Job Information Humana Medicare Enrollment Representative 2 - Remote in Lancaster South Carolina Description The Enrollment Representative 2 processes applications from members, enrolls them on company platforms, and transmits enrollment to ..
Description If you are a problem solver, resourceful, and looking to make a difference for your family as well as others we want you on our team. Help us deliver exceptional ..
Description Are you passionate about contributing to the well-being of the Medicare population? Are you looking for a role that will let your creative ideas, relationship management and sales ability shine? ..
Job Information Humana UM Administration Coordinator 2: REMOTE/WORK AT HOME (ANYWHERE IN THE US)) in Lancaster South Carolina Description This UM Administration Coordinator 2 will contribute to administration of pre-certifications, DME, ..
Description Responsibilities If you are a problem solver, resourceful, and looking to make a difference for your family as well as others we want you on our team. Help us deliver ..
Description Assist with maintenance of Automated Dispensing Systems (ADS) servers/consoles in support of DEA- and Board of Pharmacy (BoP)-compliant remote medication dispensing in Hospice IPU settings. Support implementation project management. Assist ..
Description Upstate South Carolina (Oconee County, Anderson, Greenville County) and Northeast GA (Madison, Elbert, Banks, Franklin County) The Medical Records Retrieval Specialist/ Risk Adjustment Representative 2 conducts quality assurance review of ..
Description Humana is continuing to grow nationwide! We have 28 new Bilingual Medicaid Inbound Contact Representative openings that will have the pleasure of taking inbound calls from our Florida Medicaid Members ..
Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..
Job Information Humana Manager, Fraud and Waste-Remote US in Lancaster South Carolina Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and ..
Job Information Humana AVP, Stars and Risk Adjustment National Medical Director in Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that ..
Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships in the Service Fund Department with a focus on improving the provider experience and achieving path-to-value goals through analysis and ..
Description The Senior Professional collaborates with healthcare professionals, pharmacists, and other business functions to implement formulary and medical strategies for the Medicaid line of business. Makes decisions on moderately complex to ..
Job Information Humana Call Center Pharmacy Claims Technician in Lancaster South Carolina Description Job Description Summary The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The ..
Description The Healthcare Financial Analyst collects, analyzes, and reports on various market data, connecting operational effectiveness and member experience to financial outcomes. Responsibilities The East Central Region is seeking a Healthcare ..
Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..
Description The Senior Value-Based Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Analyst works on problems of diverse ..
Job Information Humana AVP, MD, Stars and Risk Adjustment Clinical Strategy and Leadership in Lancaster South Carolina Description The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to ..
Job Information Humana Risk Adjustment Representative 3- Scheduler in Lancaster South Carolina Description The Risk Adjustment Representative 3 (Scheduler) conducts quality assurance review of medical records and ICD-9/10 diagnosis codes that ..
