Sr. Program Delivery Professional, Claims

Senior Program Delivery ProfessionalBecome a part of our caring community and help us put health first. Join Humana's In Home Well-being Assessment (IHWA) team and take ownership of critical claims operations that ensure compliance and accuracy for Medicare members. As a Senior Program Delivery Professional, you'll manage vendor claims processes, monitor compliance, and drive quality improvements.Key Responsibilities:Oversee setup, management, and monitoring of IHWA and Stars vendor claims.Ensure accurate claims submissions and payments per contract fee schedules.Partner with internal teams and vendors to resolve issues and maintain compliance with CMS and Medicare Risk Adjustment requirements.Support auditing processes for corrected claims, deletes, and no-show visit workflows.Utilize CAS, eHub, CIS, Coding, RGI rules, and claims auditing tools to maintain accuracy and efficiency.Operate independently, manage multiple tasks/projects, and make decisions in ambiguous situations.Proactively identify issues, communicate findings, and influence process improvements.Use your skills to make an impactRequired Qualifications:Bachelor's degree or equivalent years of experience5 or more years of claims experienceStrong knowledge of Microsoft Office XP products (Word, Excel, Access)Excellent communication skills, both oral and writtenMust be passionate about contributing to an organization focused on continuously improving consumer experiencesPreferred Qualifications:Master's Degree in Business Administration or a related fieldPMP certification a plusKnowledge and experience in health care environment/managed careStrong analytical skillsAdditional Information:Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial securityboth today and in the future, including:Health benefits effective day 1Paid time off, holidays, volunteer time and jury duty payRecognition pay401(k) retirement savings plan with employer matchTuition assistanceScholarships for eligible dependentsParental and caregiver leaveEmployee charity matching programNetwork Resource Groups (NRGs)Career development opportunitiesTo 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 40Pay 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. $86,300 - $118,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.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.Application Deadline: 12-11-2025Humana 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.