Become a part of our caring community and help us put health first
 

Grow your leadership skills and advance your career in this exciting role as a Supervisor, Authorizations & Claims Processing! Serving as an integral member of the management team, the Supervisor, Authorization & Claims (AC) Processing is a content expert in their assigned service categories and is responsible for the day-to-day authorization and claims support of those areas. This role will partner with other leaders to build operational synergies and drive efficiencies for the organization.

Lead the authorization and claims function of the organization in assigned teams.

• Supervise the Authorization and Claims Representatives
• Partner with other Authorization and Claims Support Leaders to identify daily support service category needs and assign supports accordingly.
• Ensure the team has the training, resources, technology, and access to information needed to complete their duties in a timely manner.
• Monitor authorization and claims functions and address non-compliance with regulatory requirements or policy/procedures.
• Develop appropriate source information to educate users on authorization and claims practices.
• Monitor and analyze processes and systems for effectiveness and implement process improvement methods.
• Collaborate with internal and external stakeholders to resolve authorization or claims issues in a timely manner.
• Utilize available reports to track and monitor benchmarks and trends and report findings to leadership.
• Track and support provider appeals and complete reprocessing as needed.
• Support provider contract approval process as needed.
• Lead and/or participates in projects related to authorization and claims processing.
• Provide training and support to colleagues and other stakeholders regarding authorization and claims processing.
• Participate in workgroups as needed to support organizational collaboration and goals,

Develop, maintain and manage authorization and claims policy and procedures

• Collaborate with other Authorization & Claims Leaders and other involved parties to update policy and procedures related to authorization and claim functions of the organization at least annually.
• Provide leadership and guidance on issues related to assigned team responsibilities. .
• Research and analyze authorization and claims processes and systems to ensure competency.
• Assess authorization and claims practices for potential risk and non-compliance and implement practice to mitigate.

Use your skills to make an impact
 

Required Qualifications

• 1 or more years of leadership/management experience
• 2+ years of Managed Care experience
• Proficiency in Microsoft Applications
• Reside in the State of WI

Preferred Qualifications

• Associates Degree or higher

Additional Information

• Workstyle: Hybrid Home - This is a hybrid home position where employees primarily work from their home office, occasionally using company office space for collaboration and face-to-face needs.
• Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1