Humana Looking For Pharmacy Claims Professional 2 at Green Bay, WI Full Time

The Pharmacy Claims Professional 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Pharmacy Claims Professional 2 is responsible for building and managing pharmacy benefit plans for all lines of Humana’s business. The associate in this role analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. 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.

Location: Work at home

Responsibilities:
Implementation and maintenance of Humana’s pharmacy benefit plans

Claims validation to ensure all pharmacy benefit plans are functioning as designed

Group and Member issue resolution, which includes researching and responding to escalated issues

Claims monitoring and reporting to ensure 100% of claims are paid accurately

Participation in monthly release cycles to implement new claims processing code with Humana’s pharmacy claims vendor

Assist in creation and maintenance of department process documentation

Assist in department process improvement initiatives to reduce risk and waste

Required Qualifications

Bachelor’s degree or equivalent work experience

Experience with data analysis & problem solving skills

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

Strong verbal and written communication skills, including the ability to tailor communication to audience

Strong organizational and time management skills

Ability to handle multiple tasks, meet deadlines, and follow-up timely

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

Preferred Qualifications

Previous experience with pharmacy benefits management

Claims experience

Pharmacy Technician experience

Additional Information

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

If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.

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 25×10 (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

Scheduled Weekly Hours

40