- Humana (Oklahoma City, OK)
- …a part of our caring community and help us put health first** The Claims Research & Resolution Representative 2 manages claims operations that involve customer ... contact, investigation, and settlement of claims for and against the organization. Approves all claim...forward to next round of interviews. This is a remote position \#LI- Remote **Scheduled Weekly Hours** 40… more
- Humana (Oklahoma City, OK)
- …to drive improvements in quality and/or reductions in total cost of care + Scorecard creation and reconciliation of provider performance based on contractual ... Qualifications:** + Bachelor's Degree + 3-5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care +… more
- Marriott (Oklahoma City, OK)
- …as injured worker advocate assisting them to set goals and participate in their care . + Recommend referral to Associate Resource Line as needed. + Coordinate ... **Additional Information** Nurse CARE Manager ( CARE - Coordinated Action...jurisdiction. This position is responsive to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health… more
- Humana (Oklahoma City, OK)
- …hands-on experience with healthcare data such as medical, behavioral, pharmacy claims data, financial, social and demographic data; demonstrated innovative and ... experience in health insurance domain, familiarity with products, providers and claims processing. + Experience with Data Warehousing (Azure/SQL/Synapse), ETL (Azure… more
- Humana (Oklahoma City, OK)
- …more years of experience with CMS and/or AHCA compliance + 2 or more years Claims experience + 2 or more years Audit and/or Financial Recovery experience + SQL ... structure and design **Preferred Qualifications** + Direct experience working with Medicare claims + Working knowledge of CPT, ICD10 and HCPC + Provider contract… more
- Humana (Oklahoma City, OK)
- …to business & customers we serve using the latest in software technology? Our claims services team is best positioned in building modernized claims eco systems ... space lacking ongoing interruptions to protect member PHI / HIPAA information \#LI- Remote **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below… more
- Humana (Oklahoma City, OK)
- …**Preferred Qualifications** + Appeals/Utilization Review/Quality Management experience + Previous claims experience + Experience working with MCG guidelines + ... HCPCS, DRG use + Experience with TRICARE contracts and/or the military health care delivery system + Knowledge of TRICARE policies and programs + Bachelor's degree… more
- Humana (Oklahoma City, OK)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position **Scheduled Weekly Hours** 40 **Pay Range** The… more
- Humana (Oklahoma City, OK)
- …+ Intermediate to advanced experience in programming, analytical work, and with claims data. + Familiarity or prior experience with data governance and literacy. ... requirements and guidelines. **Additional Information** + **Travel** : None + **Workstyle:** Remote + **Core Workdays & Hours:** Typically, 8-5 pm Monday - Friday;… more
- Humana (Oklahoma City, OK)
- …for complex accounts + Experience analyzing a wide variety of health or claims related data **Additional Information** **Why Humana?** At Humana, we know your ... space lacking ongoing interruptions to protect member PHI / HIPAA information \#LI- Remote **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below… more
- Humana (Oklahoma City, OK)
- …**Use your skills to make an impact** **WORK STYLE:** Primarily work at home/ remote with 5-10% travel. Employees are welcome to work from a local Humana ... CCS, CFE, AHFI) + Analytical background + Understanding of healthcare industry, claims processing and investigative process development + Experience in a corporate… more