Senior Payment Integrity Professional

Senior Payment Integrity Professional

Become a part of our caring community and help us put health first. The Senior Payment Integrity Professional uses technology and data mining to detect anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud, waste, and our financial recovery. The Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Payment Integrity Professional contributes to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and by ensuring correct claims payment. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact.

Required Qualifications

Bachelor's degree in Business, Finance, Healthcare Administration, Data Analytics, or a related field, or equivalent work experience.

Demonstrated experience in claims analysis, payment integrity, or healthcare data analytics, preferably within a managed care or payer environment.

Advanced proficiency in data mining tools (e.g., Power BI) and techniques for detecting overpayments.

Strong analytical and critical thinking skills; ability to evaluate complex data and variable factors to draw in-depth conclusions.

Ability to work independently with minimal direction, exercising sound judgment and considerable latitude in determining approaches to assignments.

Proven ability to manage and make decisions on moderately complex to complex technical issues and projects.

Effective communication and interpersonal skills, including the ability to influence departmental strategy and collaborate with cross-functional teams.

Preferred Qualifications

Master's degree in a related field.

Experience leading people, projects, and / or processes.

Experience using the following systems : CAS, CISpro, and CIS.

Experience with provider contract payment analysis and knowledge of payer systems.

Knowledge of relevant regulatory requirements and industry best practices in claims payment integrity.

Familiarity with audit processes and recovery operations in a payer environment.

Experience in a fast-paced, metric-driven operational setting.

Additional Information

As part of our hiring process for this opportunity, we will be using an 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.

To ensure Home or Hybrid Home / Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office employees must meet the following criteria : At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connection can be used only if approved by leadership. Employees 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 employees 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. 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. $71,100 - $97,800 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 : 12-11-2025

About Us : Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers, and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.