Medical Director--Claims Management

Are you a visionary leader with a passion for improving healthcare outcomes? Do you have a strong background in claims management and a desire to make a meaningful impact in the industry? If so, Humana is looking for a dynamic Medical Director to lead our Claims Management team. As the Medical Director, you will play a critical role in ensuring the accuracy and efficiency of our claims process, while also driving innovation and quality improvement initiatives. Our ideal candidate has a medical degree and extensive experience in claims management, as well as strong leadership and communication skills. If you are ready to join a company that is committed to transforming healthcare, we encourage you to apply for this exciting opportunity.

Evaluate and oversee the claims management process to ensure accuracy, efficiency, and compliance with industry regulations.
Develop and implement strategies to improve healthcare outcomes and reduce costs through effective claims management.
Lead and manage a team of claims professionals, providing guidance, support, and mentorship to promote a positive and productive work environment.
Collaborate with cross-functional teams, including finance, operations, and legal, to drive innovation and quality improvement initiatives.
Stay updated on industry trends and changes in regulations related to claims management and implement necessary changes to maintain compliance.
Analyze claims data to identify trends and opportunities for process improvements.
Work closely with healthcare providers to resolve complex claims issues and ensure timely payment.
Communicate regularly with leadership and stakeholders to provide updates on claims management performance and initiatives.
Develop and maintain strong relationships with external partners, such as insurance networks and vendors, to ensure efficient and effective claims processing.
Represent the company in regulatory and industry meetings and conferences related to claims management.
Provide expert medical guidance and support to claims team, including review of complex medical cases and determination of appropriate payment.
Act as a liaison between the claims team and other departments, ensuring smooth communication and collaboration to achieve company goals.
Continuously assess and improve claims processes to streamline operations and increase efficiency.
Serve as a role model for ethical and professional behavior, promoting a culture of integrity and accountability within the claims team.
Mentor and develop team members to enhance their skills and advance their careers within the organization.

Humana is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

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