Medicaid Claims Administration Coordinator (UM, UR, PA)

Overview

Join a compassionate team at Humana as a UM (Utilization Management) Administration Coordinator 2, supporting the administration of Medicaid claims for Kentucky's Medicaid plan. This role involves a variety of moderately complex administrative, operational, and customer support duties including data computations and semi-routine tasks.

Responsibilities

The Coordinator offers critical non-clinical assistance that supports processes to ensure members receive optimal care, treatment, or services. Decision-making focuses on interpreting departmental policies and determining methods for completing assignments. While tasks operate within defined guidelines, prioritization and scheduling have some flexibility.

Qualifications

• Minimum two years’ experience handling medical claims.
• At least one year working with Medicaid programs.
• Two or more years of experience in Utilization Review and/or Prior Authorization activities within managed care organizations.
• Minimum two years in administrative roles or similar healthcare, insurance, or managed care capacities.
• Proficient with Microsoft Office suite, including Word, Excel, and Outlook, plus an ability to learn new software quickly.

Preferred Skills

• Familiarity with electronic medical records and documentation systems.
• Understanding of medical terminology and ICD-10 coding.
• Previous member service or customer support phone experience.

Additional Information

• Work schedule from Monday to Friday, 8 AM to 5 PM ET or CT, with flexibility for overtime.
• This is a fully remote role for employees based in the United States.
• Home work environment must have dedicated quiet space and meet minimum internet specifications: 25 Mbps download and 10 Mbps upload speeds preferred via wireless, wired cable, or DSL. Humana reserves the right to require upgrades if necessary for business needs.
• Occasional travel to Humana offices for training or meetings may be required.
• Standard weekly hours total 40.
• Starting annual salary ranges between $40,000 and $52,300, varying by geography and candidate qualifications.
• Comprehensive benefits include medical, dental, vision, 401(k), paid time off and holidays, parental and caregiver leave, disability coverage, life insurance, and more focused on whole-person wellness.

Company Background

Humana Inc., a leading US healthcare company, delivers care and service to millions including Medicare and Medicaid beneficiaries, families, and communities. Humana emphasizes quality of life improvements through its insurance and healthcare services.

Equal Opportunity Policy

Humana maintains a strict non-discrimination and affirmative action policy, prohibiting discrimination based on protected characteristics and ensuring employment decisions are based solely on valid job requirements across all stages of personnel management.