Consumer Service Operations Professional

Are you looking to join a team where you can be a part of our important mission of supporting the TRICARE healthcare program for our nation's military? Humana Government Business is a top 10 Department of Defense contractor, with a long history in the TRICARE business and has recently been awarded the T-5 East Region, the next generation of military health contracts. The Consumer Service Operations Professional 2 is a role on the Claims Oversight Team, responsible for the accuracy of claims payment and oversight. The Consumer Service Operations Professional 2 will perform analysis by reviewing claims payments, policies, procedures and systems to the extent possible to determine whether the system is functioning accurately and if not determine root cause.

Responsibilities

This position requires a strong knowledge of claims and how to apply policy to claims processing accuracy. The Consumer Service Operations Professional 2 will collaborate with other subject matter experts to support analyzing impacts related to our business success. May assist as needed in one or more of the following benchmarking, business process analysis, claims processing, testing updates and claims quality audits.

Key Accountabilities -

• Meets established expectations and takes responsibility for achieving results
• Acts as a claims subject matter expert
• Performs claim analysis and summarize results with detail at the individual level and determine impacts
• Proactively identifies improvement opportunities based on analysis
• Effectively leverages resources to create exceptional outcomes and constructively resolves barriers
• Ensure the appropriate identification of root cause through established intake process

Required Qualifications

• Experience facilitating meetings with internal and external customers on a regular basis
• Experience with Microsoft Excel (to include creating pivot tables and basic formulas)
• Experience with claims adjudication, systems, support and reporting
• 5 years claims processing experience
• Experience with problem-solving and analytical skills
• Our Department of Defense Contract requires U.S. citizenship for this position
• Experience in process improvement projects
• Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

Preferred Qualifications

• Experience with the Tricare program
• Experience with claims and reimbursement methodology
• Bachelor's degree
• Experience with data extract and analytics software packages
• Knowledge in data collection and reporting

Work at Home Requirements

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• 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
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Satellite, cellular and microwave connection can be used only if approved by leadership

Scheduled Weekly Hours

40