Company Profile

Become a part of our caring communityThe Claims Senior Business Analysis performs analysis of business, process and user needs, documentation of requirements, cost/benefit analysis and translation into proper system requirement specifications. This position will work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises considerable latitude in determining objectives and approaches to ...

Become a part of our caring communityHumana/iCare is looking for a Claims Research and Resolution Representative to join our growing team. Reporting to the Manager, Claims Research & Resolution, you will resolve complex claims processing issues. You will work on provider claims projects, review complicated and unique claims scenarios, and serve as an important resource in identifying solutions. You will resolve member billing concerns, collaborate across departments to address operational challenges, ...

Become a part of our caring communityThe Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Process Improvement Lead will work closely with the Authorization and Referral Process team on large scale initiatives and new concepts to help translate ...

Become a part of our caring communityThe Medical Director uses their medical background, experience, and judgement. You will make determinations whether they should authorize requested services, request level of care, and requested site of service at the Initial or Appeals/Disputes level. All work occurs within a context of regulatory compliance. Diverse resources assist work, including national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching ...