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Humana Pharmacy Claims Manager-Overpayment in Indianapolis, Indiana

Description

The Manager, Pharmacy Claims works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The manager will lead a team of 4-8 individuals and assist with the development and implementation of the following overpayment programs: Medicare Secondary Payer, Commercial COB, Commercial vs Medicare Part B and Commercial Retro-term. May include additional overpayment processes related to Part A vs Part D, Part B vs Part D and review of pharmacy claims containing invalid claim elements.

Responsibilities

The Manager, Pharmacy Claims analyzes and answers inquiries regarding pharmacy claims adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross-departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Job Duties to include the following:

  • Leading a team of four to eight associates

  • Managing inventory, and assigning work

  • Assisting in the development of analytics and reports needed to support the day- to- day business.

  • Assist in establishing solid metrics

  • Facilitate training and onboarding new associates

  • Collaborate on creation of training materials

  • Assist with payer to payer system buildout

  • Provide daily guidance and oversight

  • Effectively collaborate with other Humana departments and PCAR teams and maintain frequent contact with other managers across the department

  • Aid in the development of analytics and reports needed to support the day to day business

  • Assist with developing and documentation of process

  • Participate in implementation of new auditing system

  • Will be responsible to ensure system includes all aspects of new work streams

Required Qualifications

  • Bachelor's Degree and 6+ years Pharmacy Claims experience, or equivalent

  • 2+ years of direct leadership experience and demonstrated ability to lead, coach and mentor teams

  • Data driven; strong business acumen and analytical

  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

  • Exceptional organizational & time management, interpersonal, written, and oral communication and presentation skills

  • Ability to collaborate with multiple cross functional teams & vendors; internally and externally

  • Strong ability to multi-task, meet deadlines, and follow-up timely

  • Ability to compile, analyze, interpret and integrate information and to prepare and present complex reports, statements, policies & procedures

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

  • Ability to travel to up to 25%

Preferred Qualifications

  • Reside in the Louisville area, or within a commutable distance

  • Previous experience with pharmacy benefits management

  • Knowledge/experience working with SQL (via MS SQL Server, Oracle, PL/SQL or other)

  • Knowledge/experience working with Microsoft Access

  • Pharmacy Tech experience

  • Previous experience with Medicare Secondary Payer

  • Experience with pharmacy overpayment processes

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we may use an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first-round interview, you may receive an email correspondence inviting you to participate in a Montage Voice/Text interview. In this interview, you will listen/read a set of interview questions over your phone or computer and you will provide recorded/typed responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded/text interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

  • Alert:

Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

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