Compliance Prof 2/Process and Market Support- Remote in US

Profile

Job Information

Humana

Compliance Prof 2/Process and Market Support- Remote in US

in

Portland

Maine

Description

Do you crave new challenges and solving problems? Are you looking for an opportunity to grow in the Medicaid business? Are you interested in utilizing your critical thinking skills to improve the Humana processes and associate experience? As a Critical Inquiry Process and Market Support Professional 2, you will work to convert data into actionable insights and improve operational efficiencies. You will be responsible for combining and analyzing diverse types of data to extract actionable discoveries made by business partners and Regulatory agencies. You will present and share data points with various internal departments.

Responsibilities

Where you Come In

Do you crave new challenges and solving problems? Are you looking for an opportunity to grow in the Medicaid business? Are you interested in utilizing your critical thinking skills to improve the Humana processes and associate experience? As a Critical Inquiry Process and Market Support Professional 2, you will work to convert data into actionable insights and improve operational efficiencies. You will be responsible for combining and analyzing diverse types of data to extract actionable discoveries made by business partners and Regulatory agencies. You will present and share data points with various internal departments.

Responsibilities

Ensure accountability of State Regulations and Agency expectations

Continuous collaboration with our organization and business partners to fulfill data needs

Prepare and present data to cross-functional departments on a regular basis

Identify and analyze gaps in business process which includes remediation

Collaborate closely with the Resolution Process team to create, update, and implement new and existing processes

Accountable for identifying and cascading pertinent information

Research and identify compliance issues

Conducting a comprehensive analytic review of all documents related to monthly state data

Understand and relate department, segment, organizational strategy and operating objectives

Makes decisions regarding own work methods, in ambiguous situations, and require minimal direction

Support Team Lead and Leaders as needed

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed

Minimum of 2 years' experience of health insurance to include each of the following: strong claims investigational skills; extensive background in Service Operations; and a strong understanding of CAS or MTV (Legacy Systems)

Excellent Microsoft skills Word and Excel

Excellent organizational and investigational skills

Written correspondence/professional writing experience

Requires an 18-month time in job commitment

Strong Analytical skills

Ability to manage multiple or competing priorities and meet deadlines

The hours are a minimum of 40 hours per week Monday- Friday. Core hours are between 8:00AM and 5:00 PM EST. Additional hours can be expected due to compliance deadlines provided by the state.

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

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration.

This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

Bilingual (English and Spanish); with the ability to read, write, and speak English and Spanish

Prior experience with Medicaid

Bachelor's degree

Additional Information - How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com