Payment Integrity Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in the execution of strategic initiatives and IT projects at the senior level.

• Evaluate and quantify the financial implications of process modifications and the requirements for new technologies.

• Build and maintain relationships with vendors.

• Work in collaboration with both internal business units and external stakeholders.

• Provide updates to leadership regarding roadmap initiatives, product advancements, milestones, and transition updates.

• Supervise and grow a team of over 6 Product Owners and Project Managers.

• Direct the requirements gathering, oversee project management, conduct user acceptance testing, and provide production support, training, and education.

• Develop and present project status updates and financial implications to senior executives.

• Support leaders managing multiple high-priority projects.

• Spearhead cross-functional initiatives.

• Utilize data from both internal and external sources to offer insights to decision-makers.

• Counsel executives on functional strategies and significant issues.

• Apply independent judgment and decision-making on complex matters with minimal supervision.

⛳️ Requirements

• A minimum of 5 years of experience in reading and interpreting claims.

• At least 3 years of experience in project leadership.

• Extensive knowledge of Microsoft Office applications including Word, PowerPoint, and Excel.

• Proficient in data analysis and/or situational analysis.

• Exceptional independent judgment and decision-making skills for complex issues.

• Capability to manage multiple priorities effectively.

• Ability to maintain confidentiality.

• Strong written and verbal communication skills.

• Enthusiasm for contributing to an organization that emphasizes continuous improvement in consumer experiences.

• Bachelor's Degree preferred.

• Experience in leading people and/or processes is preferred.

• Background in Financial Recovery is preferred.

• Familiarity with CAS, MTV, CISpro, and CIS is preferred.

• Knowledge of Microsoft Office applications Access and Project is preferred.

• Experience in a fast-paced, metrics-driven operational environment is preferred.

• Project Management Professional (PMP) Certification is preferred.

• Bilingual proficiency in Spanish and English is preferred.

• A minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet.

• Ability to work from a dedicated space free from ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and 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.

• Internet expense reimbursement for associates working from home in California, Illinois, Montana, or South Dakota.

• Telephone equipment provided for Home or Hybrid Home/Office associates.

• Remote work arrangement with occasional travel to Humana offices for training or meetings.