Medicaid Reconciliation Professional II

Medicaid Process Improvement Professional 2

The Medicaid Process Improvement Professional 2 is responsible for analyzing and evaluating the effectiveness of existing Medicaid business processes, with a focus on eligibility, enrollment, claims, and compliance workflows. This role develops sustainable, repeatable, and measurable improvements that align with Medicaid program requirements and regulatory standards. The role demands independent judgment to determine the most appropriate course of action, particularly when addressing operational inefficiencies, system discrepancies, or member-level variances. The professional collaborates closely with cross-functional teams, including state agencies, managed care organizations, and internal stakeholders, to drive process enhancements that improve member outcomes and operational accuracy.

The Medicaid Reconciliation Professional II supports process improvement initiatives by analyzing and enhancing Medicaid-related financial and operational workflows. This role involves researching best practices within and outside the organization to establish benchmarks and improve reconciliation accuracy, timeliness, and compliance. The ideal candidate should possess strong attention to detail with the ability to identify and resolve discrepancies and the ability to interpret and apply Medicaid policies and procedures.

Key responsibilities include :

• Data Collection & Analysis : Gather and evaluate Medicaid eligibility data to identify discrepancies and opportunities for process optimization and state submissions
• Process Enhancement : Collaborate with the Senior Professional and Leads and recommend and implement business practices that improve reconciliation efficiency, reduce errors, and support regulatory compliance
• Technology Integration : Assess how new systems and tools can streamline Medicaid reconciliation processes and support automation efforts
• Share feedback with the Senior Business Systems Analysis Associate for appropriate fix implementation
• Strategic Alignment : Understand departmental and organizational goals, ensuring reconciliation processes align with broader Medicaid and healthcare compliance strategies
• Decision-Making : Exercise independent judgment in routine tasks and contribute to problem-solving in ambiguous situations with minimal supervision
• Guideline Adherence : Follow established procedures while identifying areas for improvement and innovation

Key Performance Indicators (KPIs) :

Required Qualifications :

Work-At-Home Requirements :

Preferred Qualifications :

Additional Information :

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 : 11-21-2025

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.