Senior Claims Research amp Resolution Professional - Oklahoma City OK

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Job Information

Humana

Senior Claims Research & Resolution Professional - Oklahoma City, OK

in

Tulsa

Oklahoma

Description

The Senior Claims Research and Resolution Professional (Claims Manager) manages claims operations for the market. They are responsible for management and administration of provider claims issues related to Humana's network of providers. Manages objectives and determines approach, resources, and goals.

Responsibilities

Oversee market activities and services related to claims administration.

Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other leaders across the market.

Work towards the resolution of claims, files, systems issues and identification and complaints and issues resolutions.

Ensures the claims handling and communication is compliant with OHCA(Oklahoma Health Care Authority) regulations and company procedures and policies are followed.

Perform root cause and audits of claims projects to determine trends and make recommendation for actions.

Create innovative solutions to automate processes, build reports dashboards and metrics to provide actionable insights. 

Actively partners with the broader Medicaid business units.

Required Qualifications

Bachelor's Degree.

6 years of claims operations experience.

2 years of management experience.

Strong Business Acumen including technical knowledge of claims system, and authorization systems.

Strong interpersonal, communication and presentation skills.

Ability to effectively interact with all levels of internal and external business partners.

Ability to work independently as well as in a team, manage time and resources to accomplish multiple tasks and meet deadlines.

Knowledge of regulatory issues and the impact on claims decisions.

Ability to resolve claim issues and determine proper course of action.

Efficiently access and navigate multiple claims systems.

Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

Must live within 25 miles of Oklahoma City, OK.

Additional Information

Direct Reports:

Up to 3.

Days/Hours:

Monday - Friday; 8:30am - 5:00pm, Central Standard Time.

Travel:

5% - 10%

(There will be no travel at this time due to business travel restrictions).

Work Location:

Office based but temporarily remote.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time.These requirements include:Access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, Dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and well-being during the hiring process.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#OKMedicaid

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com