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

Are you ready to take your pharmacy career to the next level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional, you will play a pivotal role in resolving outstanding balances related to claim reversals, all while leading process improvements and influencing departmental strategies. This is your chance to own your work, solve moderately complex to highly technical issues, and make decisions with autonomy.

With your exceptional negotiation skills, ability to directly communicate with providers and internal business partners, and strong attention to detail, you’ll thrive in our fast-paced, dynamic environment. If you excel at managing multiple projects, staying organized, and adapting to change, this is the perfect opportunity for you to drive your career forward. Join us and take the lead on building solutions that make a difference!

The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding pharmacies’ outstanding balances related to the claim reversals. Plays an active role in process improvement and building new processes.

• 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.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree.

• 5 years of data analysis & problem-solving regarding process and workflow concepts.

• Comprehensive knowledge of all Microsoft Office applications, including Access, Excel, Word, and PowerPoint.

• Effective negotiation skills.

  Strong attention to detail.

• Ability to work in a fast paced, dynamic and changing environment while managing multiple projects simultaneously.

• Strong organizational and time management skills.

• Quick learner and ability to work independently with minimum supervision.

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

• Excellent verbal and written communication skills.

Preferred Qualifications

• Previous experience in health insurance pharmacy business.

• Knowledge of SQL.

• Knowledge of Power BI.

Additional Information

“You must be authorized to work in the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role.”

Work at Home Guidance

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; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates 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 associates 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

Social Security Task:

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

HireVue Statement

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensation r