Strategic Encounter Data Governance Specialist



The Senior Encounter Data Management Professional


  • Develops and maintains business processes to oversee timely and successful submissions of encounters with errors to Medicaid/Medicare.
  • Ensures encounters with errors meet or exceed all service level agreements through reporting, collaboration, trending, and managing day-to-day inventory.
  • Looks for long-term improvements of encounter submissions processes and begins to influence department’s strategy.
  • Makes decisions on reporting needs, inventory management, and efficiencies to improve productivity of department.


  • Helps ensure encounters with errors meet or exceed all service level agreements for Medicaid/Medicare through report monitoring, escalation of aged inventory, and trending of errors.
  • Utilizes tools necessary, like Excel, SQL, or PowerBI, to report and monitor inventory daily and collaborate with different departments to achieve success.
  • Works closely with peers in the department to understand the different errors in open inventory and how they are worked each day by production staff.
  • Develops necessary reports to monitor trends day-to-day and escalate when necessary, with the appropriate teams.

Required Qualifications

  • 2 or more years of health insurance experience
  • Medical claims processing experience
  • Strong analysis, critical thinking, and analytical problem-solving skills
  • Prior work with developing and trending reports
  • Ability to manage multiple tasks and deadlines with attention to detail
  • Excellent communication skills
  • Self-starter, ability to work independently
  • Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel

Preferred Qualifications

  • 1 or more years of experience with writing SQL queries
  • 1 or more years of experience with developing PowerBi dashboards
  • Prior experience with CAS and EHUB
  • Prior experience with Medicare and Medicaid programs

Additional Information

Work-At-Home Requirements

  • Must have the ability to provide a high-speed DSL or cable modem for a home office.
  • Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  • A minimum standard speed for optimal performance of 25×10 (25mbps download x 10mbps upload) is required.
  • Satellite and Wireless Internet service is NOT allowed for this role.
  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Process

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in an SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number if it is not already on file. When required, an email will be sent from [email protected] with instructions to add the information into the application at Humana’s secure website.

Scheduled Weekly Hours


Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$69,800 – $96,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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