Payment Integrity Professional 2

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The Payment Integrity Professional 2 leverages claims data, vendor platforms, and analytic tools to identify trends, perform root cause analysis, and develop mitigation strategies that support accurate payment outcomes. This role collaborates with internal stakeholders and external code edit vendors to support pre and post implementation code editing functions. The position contributes directly to cost reduction and improved payment accuracy through data driven insights and operational execution.

Where you Come In

The Payment Integrity Professional 2 leverages claims data, vendor platforms, and analytic tools to identify trends, perform root cause analysis, and develop mitigation strategies that support accurate payment outcomes. This role collaborates with internal stakeholders and external code edit vendors to support pre and post implementation code editing functions. The position contributes directly to cost reduction and improved payment accuracy through data driven insights and operational execution.

Responsibilities

• Analyze medical claims data to identify trends, anomalies, and performance patterns related to code editing and payment accuracy
• Conduct root‑cause analysis on incorrect payment outcomes and develop actionable mitigation plans
• Support the review, testing, implementation, and maintenance of code edits, using data to validate expected outcomes
• Partner with internal stakeholders and external vendors to translate analytic findings into operational improvements
• Investigate and resolve code edit stakeholder inquiries through data research, issue analysis, and evidence‑based recommendations
• Monitor key performance metrics, identify operational risks, and proactively recommend improvements
• Drive process optimization and contribute to successful day‑to‑day operations
• Document findings, maintain reports, and communicate results to technical and non‑technical audiences

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Use your skills to make an impact

Required Qualifications -- What it takes to Succeed

• Strong analytical skills with the ability to interpret data and identify trends
• Experience conducting root‑cause analysis and developing mitigation or corrective action plans
• Ability to manage multiple priorities and shift tasks quickly based on urgency
• Working knowledge of Microsoft Word, SharePoint, and Excel
• Comfortable making decisions in a dynamic, fast‑changing environment
• Advanced problem‑solving skills, including critical thinking and collaboration
• Ability to work independently and in a team with minimal supervision
• High attention to detail and accuracy
• Strong written and verbal communication skills
• Ability to work in a fast‑paced environment
• Commitment to confidentiality, ethical practice, and professional integrity

Preferred Qualifications

• Experience using CAS
• Experience with code edit tools such as:
  • Rialtic Provider Inquiries Tool
  • ClaimsXten Web UI
  • Cotiviti What If Tool (WIT)
  • Optum CES
  • Cotiviti Claims Inquiry Tool (CIT)
  • Nucleus
  • KnowledgeSource
• Experience analyzing medical claims data and interpreting payment outcomes
• Experience with Humana code edit processes
• Experience working with internal stakeholders and external vendors
• Familiarity with PowerPoint and OneNote
• Experience with THOR rule creation and/or maintenance
• Experience leading projects or process‑improvement initiatives
• Prior experience in Claims Administration and Payment Integrity (CAPI/CCM)

Additional Information - How we Value You

• Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave

Work at Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

· 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 HireVue to enhance our hiring and decision-making ability. HireVue 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.

Application Deadline: 04-15-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health -- delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.