Humana · 22 hours ago
Senior Provider Payment Professional
United States
Full-time
Remote
Mid, Senior Level
$71K/yr - $98K/yr
3+ years expHumana Inc. is committed to putting health first, and they are seeking a Senior Payment Integrity Professional to enhance the accuracy of provider contract payments and manage claims payment processes. This role involves using technology and data analysis to detect anomalies and contribute to investigations of fraud and financial recovery.
HealthcareProperty & Casualty InsuranceHealth InsuranceVenture CapitalHealth CareInsurance
Responsibilities
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
Contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment
Begins to influence department’s strategy
Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction
Exercises considerable latitude in determining objectives and approaches to assignments
Qualification
Required
Three or more years work experience reading and interpreting claims within a managed care/health care environment
Skilled in data and/or situational analysis
Familiarity with medical record reviews
Ability to pull data, create reports, and describe outcomes
Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Strong attention to detail
Can work independently and determine appropriate courses of action
Ability to handle multiple priorities
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Bachelor's Degree
Experience leading people, projects, and/or processes
Experience in Financial Recovery
Experience using the following systems: CAS, MTV, CISpro and CIS
Knowledge of Microsoft Office Programs Access and Project
Experience in a fast paced, metric driven operational setting
Bilingual in Spanish and English
Benefits
Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
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Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Emilie Fritsch
Senior User Interface Design Engineer
Recent News
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