Senior Pharmacy Claims Professional

Profile

Description

The Senior Pharmacy Claims Professional adjudicates pharmacy claims and process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. 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

3-5 years of data analysis & problem solving regarding process and work flow concepts

Pharmacy or Medical claims experience

Demonstrated proficiency in MS Office applications including Word, Excel, and PowerPoint

Ability to handle multiple tasks, meet deadlines, and follow-up timely

Ability to work in a fast paced, dynamic and changing environment while managing multiple projects simultaneously

Strong attention to detail

Project management/Process management experience

Preferred Qualifications

Strong consultative skills and relationship building skills

Strong verbal and written communication skills

Strong organizational and time management skills

Familiar with CMS

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

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we may use an exciting interviewing technology called Montage Voice/Video or Text to enhance our hiring and decision-making ability. Montage allows us to quickly connect and gain valuable information for 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 may receive an email correspondence inviting you to participate in a Montage Voice/Video/Text interview. In this interview, you will listen/read /record a set of interview questions over your phone or computer and you will provide recorded/typed responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded/text interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert:

Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website

Scheduled Weekly Hours

40

Company info

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