Program Integrity Researcher

Job not on LinkedIn

🔥 9 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $53.7k - $72.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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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

• Review incoming referrals and documentation to ensure all relevant details are captured in the case management system • Conduct follow-up calls to members, providers, internal partners, or other involved parties to verify information and gather additional details for research or case development • Request and track medical records supporting program integrity reviews and investigations • Request, obtain, and organize claims data for analysis and review • Support analysts, investigators, and leadership by preparing case information and documentation for further review • Create and maintain accurate database records • Gather relevant information through follow-up outreach • Obtain supporting documentation such as medical records and claims data • Handle sensitive information professionally and confidentially

🎯 Requirements

• High School Diploma • Basic Computer Knowledge • Experience Conducting Telephone Outreach and Follow-up Conversations • Strong Data Entry and Documentation Skills with High Attention to Detail • Ability to Manage Multiple Assignments and Prioritize • Organizational and Time Management • US Citizenship required for this position • Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information • Self-provided internet service with at least 25 Mbps download speed and 10 Mbps upload speed • Basic Medical Claims Experience (preferred) • Experience Working with Healthcare Documentation and Databases (preferred) • Experience in Program Integrity, Healthcare, Claims Review (preferred)

🏖️ 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 • Personal wellness support • Smart healthcare decision support • Occasional travel to Humana's offices for training or meetings