Where you Come In
The Payment Integrity Professional 2 leverages claims data, vendor platforms, and analytic tools to identify trends, perform root cause analysis, and develop mitigation strategies that support accurate payment outcomes. This role collaborates with internal stakeholders and external code edit vendors to support pre and post implementation code editing functions. The position contributes directly to cost reduction and improved payment accuracy through data driven insights and operational execution.
Responsibilities
Analyze medical claims data to identify trends, anomalies, and performance patterns related to code editing and payment accuracy
Conduct root‑cause analysis on incorrect payment outcomes and develop actionable mitigation plans
Support the review, testing, implementation, and maintenance of code edits, using data to validate expected outcomes
Partner with internal stakeholders and external vendors to translate analytic findings into operational improvements
Investigate and resolve code edit stakeholder inquiries through data research, issue analysis, and evidence‑based recommendations
Monitor key performance metrics, identify operational risks, and proactively recommend improvements
Drive process optimization and contribute to successful day‑to‑day operations
Document findings, maintain reports, and communicate results to technical and non‑technical audiences
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications – What it takes to Succeed
Strong analytical skills with the ability to interpret data and identify trends
Experience conducting root‑cause analysis and developing mitigation or corrective action plans
Ability to manage multiple priorities and shift tasks quickly based on urgency
Working knowledge of Microsoft Word, SharePoint, and Excel
Comfortable making decisions in a dynamic, fast‑changing environment
Advanced problem‑solving skills, including critical thinking and collaboration
Ability to work independently and in a team with minimal supervision
High attention to detail and accuracy
Strong written and verbal communication skills
Ability to work in a fast‑paced environment
Commitment to confidentiality, ethical practice, and professional integrity
Preferred Qualifications
Experience using CAS
Experience with code edit tools such as:
Rialtic Provider Inquiries Tool
ClaimsXten Web UI
Cotiviti What If Tool (WIT)
Optum CES
Cotiviti Claims Inquiry Tool (CIT)
Nucleus
KnowledgeSource
Experience analyzing medical claims data and interpreting payment outcomes
Experience with Humana code edit processes
Experience working with internal stakeholders and external vendors
Familiarity with PowerPoint and OneNote
Experience with THOR rule creation and/or maintenance
Experience leading projects or process‑improvement initiatives
Prior experience in Claims Administration and Payment Integrity (CAPI/CCM)
Additional Information - How we Value You
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
Work at Home Requirements
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
· At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
· Satellite, cellular and microwave connection can be used only if approved by leadership
· Associates 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
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting 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.
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.
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: 04-15-2026
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.