Claims Policy Consultant – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.




Role: Claims Policy Consultant
Assignment: Provider Network Operations
Location: Louisville, Ky.

Are you a fit?
Are you an analytical thinker? Would you enjoy analyzing various types of data to identify and solve complex business problems?

Assignment Capsule
As a Provider Network Operations consultant you will: provide strategic leadership and consultation services for the PNO area. You will complete analyses and prepare business cases while interacting and building partnerships with Humana's code editing, communications, claims process and information technology teams and with external vendors.

• Assist vendors, providers and Humana market offices with questions related to Humana's claim policies.
  
• Act as a liaison between multiple business partners to identify and resolve problems and concerns
  
• Use your claims knowledge to develop policies that are compliant with state, federal, and disclosure requirements.
  
• Triage assignments based on urgency, utilizing your knowledge to ensure escalation when necessary

• Builds Trust: You honor your word by doing what you say you are going to do.
  
• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
  
• Innovate: You introduce new ideas which improve performance and productivity.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

• Bachelor's Degree
  
• Two or more years of healthcare related experience such as claims processing or medical subrogation.
  
• Comprehensive knowledge of Microsoft Word, Excel and Access
  
• Outstanding oral and written communication skills.
  
• Proven ability to influence others and produce positive outcomes.
  
• At least one year experience coordinating multiple projects in a deadline driven environment.
  
• Exceptional organizational skills.
  

• Working knowledge of Access a plus!

• You will report to the Manager of Claims Policy.