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Job Posting Title Grievances & Appeals Representative

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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Summary
About the job:
Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Customer Service Representatives
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Senior Software Engineer - Next Best Action

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**We are ...
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About the job:
searching for a Senior Software Engineer to architect, develop, and maintain action and policy platforms that enable real-time, personalized decisioning across both digital and assisted channels. These platforms determine which actions can be taken, contextual variations, and the conditions under which they are permitted, leveraging structured metadata, deterministic rule engines, and resilient backend services.This position demands expertise in microservices development, advanced database schema design, and seamless...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Blockchain Engineers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
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Director - Incident, Problem, Event Management

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Director, Problem, Incident and Event Management drives technical support teams to recover services during periods of service disruption or outages to key technology platforms/applications. The Director, Problem, Incident and Event Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment.**Key Responsibilities**_Operational Excellence_+ Lead and oversee day-to-day operations of the Enterprise IT Service Desk, managing internal teams and multiple...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Computer and Information Systems Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
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Detailed Job Information

Lead Software Engineer - Next Best Action

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**We are ...
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About the job:
seeking a seasoned Lead Software Engineer to architect and deliver the foundational services that enable real time recommendations to become dependable, auditable, and scalable outcomes. In this position, you will own the design and implementation of the State Machine (managing authoritative state and legal transitions) and Transactional Outbox (ensuring exactly-once intent emission for downstream consumers). Your solutions must be robust, traceable, and maintain high performance under significant concurrency and...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Database Architects
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
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Senior Project Manager, Healthcare (Medicare/Medicaid)

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**Humana ...
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About the job:
Healthy Horizons is seeking a Senior Implementation Business Project Manager to manage a specific defined business area (non-IT) within Humana. This role mainly focuses on the "Business" side of implementations with limited scope in the IT implementation activities. This is NOT a traditional Project Manager role.The Senior Implementation Business Project Manager will serve as a subject matter expert and provide oversight to the development of solutions to relevant non-standard contractual requirements and/or local...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Project Management Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
Project Management Institute
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Senior Financial Planning and Analysis Professional

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**TThe ...
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About the job:
Senior Financial Planning and Analysis Professional collects, compiles and is responsible for analyzing multiple sources of data to identify emerging trends or gaps in expectations of the financial performance for the WI Medicaid segment. Analyses will help define efforts to mitigate claims costs or optimize top line revenue, working in partnership with key functional areas such as clinical, provider development, and operations. The Senior Financial Planning and Analysis Professional work assignments involve moderately...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Financial and Investment Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Senior Process Improvement Professional, Care and Service Coordination Strategy & Growth

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Care and Service Coordination Strategy and Growth Senior Professional plays a pivotal role in designing and execution of Medicaid care/service coordination strategy and growth activities for Medicaid and dual Medicare/Medicaid plans (dual eligible special needs plans (DSNP) by partnering closely with Care and Service Coordination Strategy Principal and Care and Service Coordination Strategy Professionals, Process Improvement Teams, national Medicare partners, and market-based leadership teams. This role helps bring...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Management Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Compliance Lead

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Compliance Lead plays a pivotal role in ensuring that our compliance program not only meets governmental requirements but also drives process improvements across the compliance organization. We are looking for a candidate who is curious, analytical, and passionate about making a difference in the healthcare industry.**Key Responsibilities**+ **Enhance Compliance Effectiveness** : Advance the effectiveness of our compliance program by developing metrics, reporting frameworks, issue tracking, resolution strategies, and...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Lead Experience Researcher

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**The ...
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About the job:
Lead Experience Researcher will inform experience strategy by identifying priority customer segments, uncovering unmet needs, and translating insights into differentiated experience capabilities. this role partners closely with product, design, and clinical staeholders to inform journey optimization and ensure solutions are grounded in customer and market evidence. The researcher will connect customer insight to business outcomes, enabling scalable, market-relevant experiences.We are seeking a Lead Experience Researcher...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Market Research Analysts and Marketing Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Senior Provider Education Professional (Medicaid)

Humana
Saint Paul, MN
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**Become a part of our caring community and help us put health first**Humana ...
Details
Summary
About the job:
Healthy Horizons is seeking a Senior Medicaid Provider Education Professional for active markets who will serve as a key support resource to the Medicaid Provider Education Leads. This role is responsible for assisting in the development, updating, and annual review of provider education materials to ensure a best-in-class provider experience for Humana's Medicaid segment. In this supporting capacity, the position aids in analyzing state contract language, updating content, and facilitating the annual review process...
Location:
Saint Paul, MN
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
From:
US.jobs
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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