Pharmacy Claims Professional 2 Data Analyst

Profile

Description

The Pharmacy Claims Professional 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Pharmacy Claims Professional 2 analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

Bachelor's degree in Business, Computer Science, or related field or equivalent combination of education and experience

Comprehensive knowledge of Microsoft Office applications, including Access, Word & PowerPoint; with strong knowledge of Excel for data analysis and reporting

Intermediate experience working with SQL (via MS SQL Server, Oracle, PL/SQL) or SAS

Experience working with large volumes of data (summarizing, reviewing for anomalies)

Ability to self-motivate & be inquisitive; strong critical thinking, and analytical skills with the ability to manipulate data and detect trends

Excellent verbal and written communication skills necessary to present information to leadeship & other cross functional areas.

Strong organizational skills, with a demonstrated ability to manage multiple task and meet deadlines, and follow up in a timely manner

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

Preferred Qualifications

Experience working in pharmacy/healthcare claims

Experience working with Power BI a plus

Pharmacy Tech experience

Scheduled Weekly Hours

40

Company info

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