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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 ..
... 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..
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..
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 ..
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 ..
... 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..
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 Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, ..
... 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..
Job Information Humana Senior Financial Analyst - Remote Nationwide in Honolulu ... Hawaii Description The Senior Financial Analyst for Humana's Direct Contracting Entity, ... operational effectiveness. The Senior Financial Analyst..
Job Information Humana Senior Process Improvement Professional/HGB (TRICARE Benefits, Claims processing exp.) Remote Nationwide in Honolulu Hawaii Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..
Job Information Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Honolulu Hawaii Description The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business ..
Job Information Humana Pharmacy Claims Specialist, Remote in Honolulu Hawaii Description Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. ..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Honolulu Hawaii Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
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 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 ..
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. ..
