Medicaid Claims Administration Coordinator, UM, UR, PA

🕒 July 31

🇺🇸 United States – Remote

💵 $40k - $52.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🖥️ Administration

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 24%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Contribute to administration of utilization management for Humana's KY Medicaid plan • Perform varied, moderately complex administrative, operational, and customer support assignments • Perform computations • Provide non-clinical support for procedures ensuring appropriate treatment, care, or services for members • Interpret department policies and methods for completing assignments • Identify work expectations and quality standards within defined parameters • Prioritize and schedule work independently within standard policies • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• 2+ years of experience in medical claims • 1+ years of Medicaid experience • 2+ years of experience with Utilization Review (UR) and/or Prior Authorization (PA) processes within a managed care organization • 2+ years of administrative experience or experience in a similar healthcare, insurance, or managed care role • Working knowledge of MS Office including Word, Excel, and Outlook in a Windows-based environment • Ability to quickly learn new systems • Proficient using electronic medical record and documentation programs • Proficient or experience with medical terminology or ICD-10 codes • Prior member service or customer service telephone experience • Ability to work Monday through Friday, 8:00 AM–5:00 PM ET or CT, with flexibility to work overtime • Home internet with at least 25 Mbps download and 10 Mbps upload speed • Work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Flexible overtime opportunities • Remote work • Dedicated home workspace support for protecting member PHI/HIPAA information