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Pharmacy Claims Lead - Financial Recovery

Humana

Humana

Accounting & Finance
Louisville, KY, USA
Posted on Monday, April 15, 2024

Become a part of our caring community and help us put health first

The Pharmacy Claims Lead - Financial Recovery leads a team that is responsible for monitoring pharmacy outstanding balances and recovering such balances in certain cases. The Pharmacy Claims Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
  • The Pharmacy Claims Lead – Financial Recovery leads a team that is responsible for monitoring pharmacy outstanding balances, determining which cases require direct outreach to the pharmacies, and negotiating financial recoveries.

  • Analyzes large sets of data and produces various reports and summaries for decision making purposes.

  • Advises executives to develop functional strategies (often segment specific) on matters of significance.

  • Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision.

  • Uses independent judgment requiring analysis of variable factors and determining the best course of action.


Use your skills to make an impact

Required Qualifications

  • Bachelor's degree

  • 5 or more years of technical experience including analyzing large sets and producing various reports and summaries

  • 2 or more years of project leadership experience

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

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

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

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

Preferred Qualifications

  • Previous experience with pharmacy benefits management

  • Claims experience

  • Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)

Additional Information

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  • Satellite, cellular and microwave connection can be used only if approved by leadership
  • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#LI-PH1

Social Security Task:

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will 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.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$76,800 - $105,800 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.