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Description The Senior Business Intelligence Engineer (Claims Strategy) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Senior Business Intelligence Engineer ..
Description The Provider Insights & Claims Analytics (PICA) team is a blend of technology, data, and consulting professionals leveraging the latest tools and methods to solve complex business problems. In this ..
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 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 Business Intelligence 2 - Provider Intelligence and Claims Analytics (PICA) solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The ..
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 Claims Review Representative 4 (formerly Team lead), Financial Recovery Overpayment Team makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. ..
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 ..
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 ..
... aspects related to reviewing pharmacy claim submissions for accuracy and appropriateness. ... tone and standard for pharmacy claim review. The Pharmacy Claims Professional ... pharmacies, make determination of appropriate..
Job Information Humana Senior Process Improvement Professional/HGB (TRICARE Benefits, Claims processing exp.) Remote Nationwide in Lancaster South Carolina Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing ..
Job Information Humana Senior Risk Management Professional - Pharmacy claims in Lancaster South Carolina Description The Senior Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The ..
... this role the Business Intelligence Analyst solves complex business problems and ... to decision-makers. The Business Intelligence Analyst work assignments are varied and ... well-being Responsibilities The Business Intelligence..
Job Information Humana Senior Financial Analyst - Remote in Lancaster South ... vision is to improve member healthcare through innovative analytics and actionable ... is seeking a Senior Financial Analyst..
Job Information Humana RN, Senior Stars Improvement, Clinical Professional in Lancaster South Carolina Description Humana Healthy Horizons in Florida is seeking a RN, Senior Stars Improvement, Clinical Professional who will be ..
Description The Senior Business Intelligence Analyst (Claims Strategy) solves complex business ... decision-makers. The Senior Business Intelligence Analyst work assignments involve moderately complex ... In The Senior Business Intelligence Analyst..
Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Lancaster South Carolina Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing ..
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 ..
... Humana Lead Product Manager - Healthcare API in Lancaster South Carolina ... The Lead Product Manager - Healthcare API (SME) as part of ... Individual will be leveraging previous..
Description The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of ..
Description The STARS Improvement Analyst develops, implements, and manages oversight ... and initiatives. The STARS Improvement Analyst work assignments are varied and ... well-being Responsibilities The STARS Improvement Analyst develops..
Job Information Humana Senior Financial Analyst - Remote Nationwide in Lancaster ... Carolina Description The Senior Financial Analyst for Humana's Direct Contracting Entity, ... operational effectiveness. The Senior Financial Analyst..
