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

The Payment Integrity Professional 2 for the Special Investigations Unit (SIU) Medicaid Team helps make sure compliance and program integrity are top priorities across all Medicaid Lines of Business (LOB). The role ensures compliance with contractual, statutory, and governmental reporting requirements for SIU. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

What You’ll Do:

 

• Lead a team focused on Medicaid program integrity reporting for SIU

• Research and suggest process improvements

• Collect, analyze, and interpret data for regular and ad hoc reporting

• Respond to SIU leadership’s requests for data and insights

• Keep communication flowing between the Resolution Team – Compliance Research & Reporting and SIU teams

• Use reporting tools and software (Excel, PowerPoint, etc.) to present findings

• SME for the implementation of required reporting related to SIU. 

Use your skills to make an impact
 

WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day and 5 days/week. Associates are expected to align their work hours to EST or CST, regardless of their home time zone.

Required Qualifications

• Experience in compliance reporting, Medicaid reporting, and/or SIU support

• Claims experience

• Good attention to detail, especially for contracts and reports

• Proficient with Microsoft Office (Excel, Word, PowerPoint)

• Ability to juggle multiple priorities and meet deadlines

• Strong communication and teamwork skills

• Can work independently and determine appropriate courses of action

• Capacity to maintain confidentiality

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

Preferred Qualifications

• Bachelor’s or advanced degree

• Audit, consulting, and/or compliance background

• Knowledge of Department of Insurance, CMS, and Medicaid contracts

• Experience with healthcare fraud investigations or SIU work

• Familiarity with Power BI and SQL

Additional 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.

 

$65,000 - $88,600 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 holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.