Humana Medicare Secondary Payer/ Coordination of Benefits Outsourcing Vendor Consultant ( Bilingual, Health Insurance, Data analysis and quantifiable business methods a MUST) San Juan, PR in San Juan, Puerto Rico

Role: COB/MSP - Medicare Secondary Payer/ Coordination of Benefits Outsourcing Vendor Consultant Assignment: Claims Cost Management Location: San Juan, Puerto Rico

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Assignment Capsule As an outsourcing consultant you will: serve as an expert lead and outsourcing partner liaison on process and projects, providing timely and accurate analysis on operational metrics and performance, process and tool design and testing coordination, and create documentation of complex business tasks and processes for use with outsourcing partner training, implementation, monitoring, and process enhancement. You will also assist in development of schedules and plans for the coordination and management of resources to account for outsourcing partner impacts in order to establish more efficient, effective, and cost-effective business operations. * Detect, present, and oversee offshore partner process improvements, process efficiency, and automation opportunities

  • Consult with other business areas and offshore partners to create cost benefit analyses of opportunities and prioritize current projects and initiatives

  • Initiate new contract statements of work and monitor existing contracts for service level agreement performance.

  • Prepare and present recommendations to both internal and external audiences

  • Search and lead initiatives for new offshore opportunities that could result in administrative savings and/or cost per member reductions

  • Develop and oversee IT project requests and implementation required for outsourcing partner assistance and enhancement through heavy collaboration between IT development, testing, offshore partners, and end business users Evaluate legal updates, CMS policy changes, and new legislation for impacts on existing outsourced processes

  • Other various projects as assigned

    Role Essentials

  • Management skills which include ability to assess and understand client processes, elicit client understanding, and insight to advise and make recommendations

  • Health Insurance experience

  • Prior experience in data analysis and quantifiable business methods

  • Proficient skills in Microsoft Office products (Word, Excel, PowerPoint)

  • Effective ability to evaluate existing work processes in order to predict, address and resolve efficiency and accuracy constraints

  • Excellent communication skills (both oral and written), and documentation skills

  • Ability to handle multiple tasks and deadlines

  • Leadership skills, ability to effectively engage and manage a team of associates

  • Ability to work under pressure and maintain a high level of emotional intelligence

  • Bilingual (English/Spanish). Candidate selected will not be communicating in English with members

    Role Desirables

    · Bachelor’s degree in Business or Applicable field

    · Healthcare finance or healthcare related consulting preferred

    · Experience with Subrogation and related topics (i.e. TPL, MSP, etc.)

    · Project management & process mapping experience

    · Proficient skills in Microsoft Office Access

    Reporting Relationships

    You will report to a Manager. This area is under the leadership of the SVP & Chief Operating Officer.

    Additional Information

    At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

Title: Medicare Secondary Payer/ Coordination of Benefits Outsourcing Vendor Consultant ( Bilingual, Health Insurance, Data analysis and quantifiable business methods a MUST) San Juan, PR

Location: Puerto Rico-San Juan

Requisition ID: 179774

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.