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The healthcare consultant will perform the following responsibilities: Conduct analysis of health plan and provider functional areas to identify impacts, opportunities and risks related to the implementation of ICD-10, create high ..
Description The Senior Claims Research & Resolution Professional works with operational teams, vendors, providers, and members in the processing of claims. Strong analytical skills focusing on accuracy and attention to detail. ..
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 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 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 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 ..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Cincinnati Ohio Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be responsible ..
... Humana Lead Product Manager - Healthcare API in Cincinnati Ohio Description ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..
Description The Senior Market Development Professional provides support to assigned health plan(s) relative to Behavioral Health RFPs, product implementations and operational support. The Senior Market Development Professional work assignments involve moderately ..
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 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 ..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Cincinnati Ohio Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..
... 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..
Description The Mail Operations Pharmacy Technician 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. Responsibilities The Mail Operations Pharmacy Technician 2 ensures ..
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 ..
Description The Health Information Management Professional ensures data integrity for claims errors. The Health Information Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description The Senior Product Manager role is a part of the Pharmacy Product & Growth organization and will be responsible for leading initiatives that help drive value for CenterWell Specialty Pharmacy. ..
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 ..
