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About this job

Description

The Manager, Payment Integrity – PrePayment Operations uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Manager, Payment Integrity – PrePayment Operations works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

The Manager, Payment Integrity – Prepayment Operations contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

  • Will have 6 or more direct reports including a Supervisor and Professionals and over 200 indirect reports such as offshore contractors and non-exempt personnel
  • Works with leadership in Claims Cost Management and Front End Claims Administration

Required Qualifications

  • 6+ years of work experience related to claims
  • 2+ years of supervisory leadership experience
  • Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
  • Highly collaborative with curiosity to determine best approach to drive projects to success outcomes
  • Able to determine the needed approach, resources, and goals to solve problems
  • Demonstrated experience with external departmental collaboration
  • Experience leading meetings and presenting material to broad audiences
  • Ability to handle multiple priorities
  • Capacity to maintain confidentiality
  • Excellent communication skills both written and verbal

Preferred Qualifications

  • Experience leading projects and/or processes
  • Experience with the following systems: Pareo, CAS, MTV, CISpro and CIS
  • Experience with PowerBI
  • Experience in Lucid Spark
  • Experience in Clinical Processes
  • Experience in a fast paced, metric driven operational setting
  • Project Management Professional (PMP) Certification

Additional Information

Work at Home/Remote Requirements

Work-At-Home Requirements

  • To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
    • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
    • Wireless, Wired Cable or DSL connection is suggested.
    • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
    • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
    • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
    • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue.  HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. 

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview.  Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

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Scheduled Weekly Hours

40



Request an Accommodation

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Employment Fraud Notice

Humana will never ask a candidate for money for work equipment and network access or request access to personal accounts during the application process. Learn more about identifying and preventing employment fraud or report a suspected employment fraud case.

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Upcoming Customer Care Events

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Our Hiring Process

Apply online

To be considered for a job, you must apply online. Unfortunately, we cannot accept resumes that have been emailed to us. Once you find a job that interests you, simply select “Apply.” It typically takes 15 minutes to fill out the application form. Be sure to update your resume and upload it as you cannot edit the resume or add it after the application has been submitted. Shortly after you submit your application, you will receive a confirmation.

Next Step

If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.

A hiring manager interview

After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.

Offer from Humana

If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.

Onboarding

If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.


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Hiring Process