Humana

About Humana

 

Job Category:

Consumer Service Operations - Claims Audit/Financials

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full time

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Medical/Financial Risk Evaluation Professional 2

Humana - Louisville, Kentucky

Posted: 08/9/2018

Description

The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Medical/Financial Risk Evaluation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Medical/Financial Risk Evaluation Professional 2 identifies, assesses, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. Maintains a balance between risk mitigation and efficiency. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

  • Generate comparative analyses of actual results to expected results and report your findings
  • Assist with development of reporting and processing as they relate to department enhancements
  • Partner with the Information Technology department and business areas during the design of system enhancements and issue resolutions
  • Resolve system issues as they relate to production processing, report applications and system output

               

Required Qualifications

  • Bachelor Degree
  • Strong Communication Skills (verbal and written)
  • Ability to work in potentially high stress environments
  • Excellent PC skills (including MS Word, Excel and PowerPoint)
  • Prior experience in data extraction and reporting

Preferred Qualifications

  • Significant SharePoint Experience
  • Basic SQL/Access Knowledge
  • MTV/CAS Claim Experience
  • Healthcare Experience

Additional Information

Scheduled Weekly Hours

40

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