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

Join Humana’s In Home Well-being Assessment (IHWA) team and take ownership of critical claims operations that ensure compliance and accuracy for Medicare members. As a Senior Program Delivery Professional, you’ll manage vendor claims processes, monitor compliance, and drive quality improvements.

Key Responsibilities:

• Oversee setup, management, and monitoring of IHWA and Stars vendor claims.
• Ensure accurate claims submissions and payments per contract fee schedules.
• Partner with internal teams and vendors to resolve issues and maintain compliance with CMS and Medicare Risk Adjustment requirements.
• Support auditing processes for corrected claims, deletes, and no-show visit workflows.
• Utilize CAS, eHub, CIS, Coding, RGI rules, and claims auditing tools to maintain accuracy and efficiency.
• Operate independently, manage multiple tasks/projects, and make decisions in ambiguous situations.
• Proactively identify issues, communicate findings, and influence process improvements.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or equivalent years of experience
• 5 or more years of claims experience
• Strong knowledge of Microsoft Office XP products (Word, Excel, Access0
• Excellent communication skills, both oral and written
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree in Business Administration or a related field
• PMP certification a plus
• Knowledge and experience in health care environment/managed care
• Strong analytical skills

Additional Information

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
• Paid time off, holidays, volunteer time and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities

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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$86,300 - $118,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holida