Compliance UMAC 3

Job not on LinkedIn

🔥 2 hours ago

🇺🇸 United States – Remote

💵 $44.9k - $60.2k / year

⏰ Full Time

🟢 Junior

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. • collects and analyzes data daily, weekly, monthly, or as needed to assess outcome and operational metrics for the team and individuals. • understands department, segment, and organizational strategy and operating objectives, including their linkages to related workstreams. • makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. • follows established guidelines, regulatory turnaround times, and procedures for processing QIO fast track appeals and expedited authorization requests.

🎯 Requirements

• 1 - 3 years of technical experience • Proficient in Microsoft Word & Excel • Strong attention to detail and accuracy • Must be passionate about contributing to an organization focused on continuously improving consumer experiences • Excellent verbal and written communication skills • Clerical support background in a healthcare environment • Ability to work independently in an agile environment under general instructions and within a team. • UM experience with auditing or compliance (preferred) • UM experience with processing expedited requests or QIO appeals (preferred) • Associates' or Bachelor's degree in Healthcare, Business. Finance, or related field (preferred) • Familiarity with medical terminology and/or ICD-10 codes (preferred)

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities