Payment Integrity Strategic Initiatives Lead

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The Code Edit Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Code Edit Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Lead can describe the tools, technologies, applications, and practices used to collect, integrate, analyze, and present an organization's data and processes in order to create insightful and actionable business information. The Lead will advise 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.

Primary Role Functions

Support implementation of senior level strategic initiatives and IT Projects

Assess and quantify financial impacts for process changes, new technology needs, etc.

Manage and cultivate vendor relationship.

Collaborate with internal business and external stakeholders.

Update leadership on roadmap initiatives, product progress, milestones, and transition progress.

Oversee and develop a team of 6+ Product Owners and Project Managers

Requirements gathering, project management oversight, user acceptance testing, production support, training and education.

Create and present project status updates, financial impacts, etc. to senior level executives

Manage and support leader with multiple high priority projects

Required Qualifications

5 or more years work experience reading and interpreting claims

3 or more years of project leadership experience

Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

Skilled in data and/or situational analysis

Excellent independent judgement and decision making ability for complex issues

Excellent communication skills both written and verbal

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

Experience in Financial Recovery

Experience using the following systems: CAS, MTV, CISpro and CIS

Knowledge of Microsoft Office Programs Access and Project

Experience in a fast paced, metric driven operational setting

Work at Home Requirements

• 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
• Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.