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Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of ..
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Description The Senior Pharmacy Claims Professional adjudicates pharmacy claims and process pharmacy claims for payment. The Senior Pharmacy ... for payment. The Senior Pharmacy Claims Professional work assignments involve moderately..
Description The Actuarial Analyst 2, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and ..
Description The Senior Pharmacy Claims Professional in the Pharmacy Claim ... & Review department adjudicates pharmacy claims and process pharmacy claims for payment. The Senior Pharmacy ... for payment. The..
... team conducts reviews on pharmacy claims to assess for recoveries. The ... of action. Responsibilities The Pharmacy Claims Professional 2 analyzes and answers ... and answers inquiries regarding pharmacy..
Description This Lead Actuary role requires a leader who is a creative thinker and is energized to build something from the ground-up. This team will start with a blank canvas to ..
Description The Medical Coding Coordinator 2 extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical ..
Description The Humana Pharmacy Solutions traditional Desktop Audit team oversees and manages multiple aspects related to reviewing pharmacy claim submissions for accuracy and appropriateness. Facilitation of discussions with CMS representatives and ..
Description The Supervisor, Health Information Management ensures data integrity for claims errors. The Supervisor, Health Information Management works within thorough, prescribed guidelines and procedures; uses independent judgment requiring analysis of variable ..
Description This Actuarial Analyst 2 role on the Specialty Benefits team will take ownership of our Dental and Vision commercial group (100 lives) renewal reporting and the dental trend analysis. This ..
Description The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Medical/Financial Risk Evaluation Professional 2 work assignments are varied and frequently ..
... and adjudicates complex or specialty claims, submitted either via paper or ... to return, deny, or pay claims following organizational policies and procedures. ... experience within the Healthcare and/or..
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 ..
... 2 conducts reviews on pharmacy claims to assess for recoveries. The ... of action. Responsibilities The Pharmacy Claims Professional 2 analyzes and answers ... and answers inquiries regarding pharmacy..
... will identify opportunities for appropriate claims adjudication based on benefit payment, ... first time accurate adjudication of claims and payments for members and ... 5 or more years of..
... contract is responsible for processing claims for more than 6 million ... than 6 million members, the claims processing and financial management functions ... to an external vendor. The..
Description The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly ..
