Remote Compliance UM Coordinator III — Data & Appeals Expert

Humana Inc; Augusta (ME); Remote; USD 45,000 - 60,000; Full time

Job summary

Humana Inc. seeks a Compliance (UM) Coordinator 3 to review utilization management activities and documentation for adherence to policies and regulations. The role involves interpretation and independent action within a healthcare environment.

The position operates on a three-day, 12-hour shift schedule with Friday–Sunday or Saturday–Monday options, and requires strong data analysis, attention to detail, and excellent communication. Travel to Humana offices may be required occasionally.

Qualifications

• 1–3 years of technical experience.
• Proficient in Microsoft Word and Excel.
• Strong attention to detail and accuracy.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Excellent verbal and written communication skills.
• Clerical support background in a healthcare environment.
• Ability to work independently in an agile environment under general instructions and within a team.

Responsibilities

• Review utilization management activities and documentation for policy adherence.
• Analyze data daily/weekly/monthly to assess performance metrics.
• Make decisions with independent judgment and apply critical thinking within guidelines.
• Follow established guidelines for processing QIO fast track appeals and expedited requests.

Skills

Microsoft Word

Microsoft Excel

Attention to detail

Verbal communication

Written communication

Agile environment

Independent work

Healthcare clerical experience

Education

Associates or Bachelor's degree in Healthcare, Business, Finance, or related field

Job description

Humana Inc. seeks a Compliance (UM) Coordinator 3 to review utilization management activities and documentation for adherence to policies and regulations. The role involves interpretation and independent action within a healthcare environment.

The position operates on a three-day, 12-hour shift schedule with Friday–Sunday or Saturday–Monday options, and requires strong data analysis, attention to detail, and excellent communication. Travel to Humana offices may be required occasionally.