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 The Senior Business Systems Analysis Professional performs analysis of business, process and user needs, documentation of requirements, cost/benefit analysis and translation into proper system requirement specifications. The Senior Business Systems Analysis Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

This role requires in depth knowledge of subrogation/payment integrity methodologies regarding third party liabilities and procedures, as well as the varying analytical methodologies, business systems and procedures of each of our five supporting vendors. The role also requires technical experience necessary to collaborate with IT partners and guide strategies that implement various new tools driven by AI, NLP, RPA, etc.

Subrogation is a unique & complex practice, and near-term the candidate’s background and experience will be necessary to assist the team with the technical approach for the following projects:

Manage the significant amount of project work identified to support a system migrationAssume lead role in working with the Enterprise Operations Enablement (EOE) team our Insurance AI Lean Business Case for Correspondence ModernizationDevelopment of a process to make use of COB MSP Part C&D data provided by CMS to payers to properly analyze and investigate requirements to determine other liable parties due to Medicare set aside settlement arrangements for both Part C and Part DOversee development of a repository of the COB MSP data to ensure compliance with existing and anticipated CMS requirementsInfluence department’s strategy and perform cost/benefit analysis of subrogation’s future organization model as we define the selection criteria for an RFI
Use your skills to make an impact
 

Required Qualifications

Previous knowledge or experience with payment integrity and/or subrogation experienceWorking knowledge of ad-hoc query tools and data repositories that support data extraction and manipulation such as SQL or TOADPrevious project leadership experienceKnowledge of Systems Development Life CycleExperience in problem analysis and processComprehensive knowledge of all Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio

Work-At-Home Requirements

At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates 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 associates 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

Preferred Qualifications

Advanced DegreeMinimum 5 years of payment integrity and/or previous subrogation experiencePrevious healthcare experienceSix Sigma certificationPMP certificationDemonstrated experience with process documentation and re-engineering

Additional Information

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

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.

 

$80,900 - $110,300 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.

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.

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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.