Payment Integrity Professional 2

About the Team

Humana is a leading U.S. healthcare company dedicated to making it easier for millions of people to achieve their best health. Through our insurance services and CenterWell healthcare services, we deliver the care and support our members need when they need it. Our Payment Integrity team plays a critical role in this mission by leveraging data and analytics to ensure accurate payment outcomes, directly supporting cost reduction and operational excellence.

About the Role

As a Payment Integrity Professional 2, you will be a vital part of our caring community, using claims data, vendor platforms, and analytic tools to identify trends and perform root cause analysis. This role is designed to develop mitigation strategies that support accurate payment outcomes while collaborating with internal stakeholders and external code edit vendors. You will contribute directly to the organization's goals of cost reduction and improved payment accuracy through data-driven insights and operational execution.

In this position, you will support pre- and post-implementation code editing functions, translating analytic findings into operational improvements. Your work will involve investigating stakeholder inquiries, monitoring key performance metrics, and driving process optimization to ensure the day-to-day success of our payment integrity operations.

Hiring Process

As part of our hiring process, we utilize HireVue, an innovative interviewing technology that allows us to connect with you and gather valuable insights regarding your skills and experience at a time that suits your schedule. While this is primarily a remote position, occasional travel to Humana offices may be required for training or meetings.

Work Environment & Requirements

We are fortunate to offer a remote opportunity for this role. To ensure you can work effectively from home, your internet connection must meet specific criteria (minimum 25 Mbps download and 10 Mbps upload). Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses. Humana will also provide necessary telephone equipment. You will be expected to work from a dedicated space free of ongoing interruptions to protect member PHI and HIPAA information.

Our Culture & Commitment

Humana values associate engagement and well-being, offering a Fortune 100 environment that supports your professional development and continued education. We are committed to whole-person well-being, providing benefits that encourage smart healthcare decisions for you and your family.

We are an Equal Opportunity Employer. It is Humana's policy not to discriminate against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We take affirmative action to employ and advance individuals with disabilities or protected veteran status and base all employment decisions only on valid job requirements.