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

The Director, Initial Claims supports providers, members, and collection services in the processing of claims. This role leads an organization comprised of claims associates adjudicating claims, along with researching and resolving claims inquiries. The Director, Initial Claims has oversight of and drives for continuous improvement in initial claims processing for all medical lines of business. The role will focus on meeting all required regulatory metrics and requirements, striving for back office excellence, and pursing automation opportunities. 

Role responsibilities:

• Responsible for approximately 500 Humana associates supporting and oversight of up to 700 BPO partner associates across two vendors supporting all Medical lines of business (Medicare and Medicaid)
• Focuses on improvement initiatives directed on delivering improved performance rates and optimal customer experiences
• Drives engagement efforts with Operational Business partners & Market partners, to ensure consistent identification of opportunities and best practices for improvement 
• Creates/Maintains collaborative working relationships with partners across the enterprise including Medicaid Market Leaders, Claims Process Org, Payment Integrity Org etc., in effort to create streamlined processes and improved provider/member experience
• Oversees performance oversight and roadmap toward operational excellence for Initial Claims, including deepening Vendor strategy and offshore support
• Monitors performance and operational reporting in the Claims Processing space, with regular executive summary roll-up to leadership
• Identifies and monitors inventory drivers, implements practices to drive automation and establish robust audit practices on complex projects
• Takes complex problems and distills into manageable pieces to develop solutions

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Use your skills to make an impact
 

Required Qualifications

• 5+ years' vendor and/or vendor partner experience
• 5+ years' experience managing people in a production organization
• Progressive experience in the health solutions industry
• Experience with decision making for large scale projects or new/updated programs
• Proficiency in analyzing and interpreting data and trends
• Strong attention to detail and focus on process and quality
• Excellent communication and negotiation skills, capable of interacting with both technical and non-technical stakeholders
• Excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs
• Ability to influence and drive change across large, matrixed organization

Preferred Qualifications

• Bachelor's Degree
• Proven organizational and prioritization skills and ability to collaborate with multiple departments
• Previous & progressive operational management leadership experience
• Experience with vetting/implementing software programs/tools
• Strong financial and business acumen; ability to integrate a business perspective across the enterprise

Additional Information

Travel for this role will be up to once a quarter.

Work at Home/Remote Requirements

Work-At-Home Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exce