Consumer Service Operations Professional 2
Operations
WFA Digital Insight
As the remote job market continues to expand, demand for skilled professionals in healthcare operations has grown significantly, with a 25% increase in job postings over the past year. With a strong focus on digital skills and remote work, Humana International Group is at the forefront of this shift. In this role, you'll leverage your expertise to drive process improvements and ensure seamless claims processing. With a reported 34% growth in the healthcare industry's need for analytical talent, this position offers a unique opportunity to apply your skills in a dynamic environment. Before applying, consider the importance of staying up-to-date with the latest developments in reimbursement terminology and the ability to work independently in a remote setting.
Job Description
About the Role
The Consumer Service Operations Professional 2 plays a critical role in Humana's efforts to deliver high-quality service to its members. As part of the operations team, you will be responsible for analyzing claims, identifying root causes of issues, and applying your knowledge of policies and procedures to ensure accuracy in claims processing. This role is essential to maintaining the integrity of Humana's claims process and ensuring that members receive the care they need. The day-to-day responsibilities of this position will involve reviewing claims payments, policies, and procedures to determine the root cause of issues. You will also be expected to summarize results of your analysis at the individual level and identify areas for improvement. Your expertise in claims processing will be crucial in acting as a subject matter expert and assisting with benchmarking, business process analysis, and claims quality audits. This role reports to a Manager of Business Intelligence, indicating the strategic importance of your work in informing business decisions and driving operational excellence.What You Will Do
- Perform thorough analysis of claims payments, policies, and procedures to identify root causes of issues
- Apply knowledge of claims and policy to ensure accuracy in claims processing
- Summarize results of analysis at the individual level to determine impacts and identify improvement opportunities
- Act as a claims subject matter expert to assist in various operational tasks
- Assist with benchmarking, business process analysis, claims processing, and testing updates
- Participate in claims quality audits to ensure compliance with standards
- Identify opportunities for process improvements and implement changes as approved
- Maintain up-to-date knowledge of reimbursement terminology and policies
- Collaborate with other departments as necessary to resolve issues and improve processes
- Participate in training and meetings as required, which may include occasional travel to Humana's offices
What We Are Looking For
- 3 years of experience in a managed care environment
- 4 years of experience in claims processing/adjudicating professional, inpatient, and outpatient claims
- Experience with TRICARE contracts and/or the military health care delivery system, or Medicare reimbursement
- 2 years of customer service experience
- Familiarity with reimbursement terminology (e.g., DME, DRG, HCPCS, CPT coding, Revenue codes)
- Strong analytical and problem-solving skills
- Ability to work in a remote environment with minimal supervision
- Strong communication and interpersonal skills
- Ability to maintain confidentiality and handle sensitive information
- U.S. citizenship is required for this position due to the Department of Defense contract requirements
Nice to Have
- Experience with claims analysis software and tools
- Knowledge of healthcare regulations and laws
- Certification in a related field (e.g., claims adjustment, healthcare management)
- Previous experience working in a remote or hybrid work environment
- Proficiency in additional languages
Benefits and Perks
- Competitive salary range ($58,700 - $68,200 per year)
- Eligibility for a bonus incentive plan based on company and/or individual performance
- Comprehensive benefits package, including medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off, including company and personal holidays, volunteer time off, and paid parental and caregiver leave
- Short-term and long-term disability insurance
- Life insurance
- Opportunities for professional growth and development
- Remote work stipend for associates living and working from home in certain states
- Telephone equipment provided by Humana for remote work
How to Stand Out
- Ensure your resume and cover letter highlight your experience with claims processing and analysis, as well as your knowledge of reimbursement terminology.
- Be prepared to discuss specific examples of process improvements you've identified and implemented in previous roles.
- Having a dedicated, distraction-free workspace is crucial for success in this remote position; be prepared to describe your home office setup during the interview.
- Familiarize yourself with Humana's products and services to demonstrate your interest in the company and the role.
- Don't hesitate to ask about opportunities for professional development and growth within the company during the interview.
- Make sure your internet connection meets the minimum requirements (25 Mbps download, 10 Mbps upload) to ensure you can perform your duties efficiently.
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