Humana

Compensation

Full Description

Job Description: • Provide direction and management to the claims processing vendor for claims reimbursements and operational activities • Coordinate with the Director, VA CCN Claims Oversight for alignment of accurate claims processing • Ensure a high level of quality in all areas while meeting or exceeding performance goals • Oversee claims processing activities performed by external vendors • Monitor and review claims payment processes, identifying opportunities for process improvement and risk mitigation • Direct the reconciliation of claims payments, maintaining detailed records and ensuring resolution of discrepancies • Manage accounts receivable and recoupment processes • Lead banking coordination and reporting activities • Serve as a key liaison between internal stakeholders and claims vendors to optimize operational efficiency and compliance with regulatory standards Requirements: • U.S. Citizenship required for this role • Must successfully receive interim approval for government security clearance (NBIS- National Background Investigation Services) • Bachelor's degree in Accounting, Finance, Business, Health Care Administration, Government Contract Management, or Operations Management or if non-degree, must have at least 5 years of experience with TRICARE and/or VA CCN in claims or financial transaction area • 5 years of experience in a managed care environment and financial transactions and claims area • Experience with VA, TRICARE contracts and/or the military health care delivery system, and/or Medicare reimbursement • Experience with data analysis and making decisions using data. Benefits: • 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