Encounter Data Management Medicaid Research Professional

Become a part of our caring community

The Encounter Data Management Medicaid Research Professional ensures accurate and compliant Medicare and Medicaid encounter submissions. You will use data analysis and process improvement techniques to increase submission acceptance rates and operational efficiency. Work independently on routine to moderately complex issues and support departmental goals through process improvement.

• Manage and analyze large datasets related to Medicaid claims and encounter data to identify trends and patterns.
• Maintain data quality control processes to ensure accuracy and completeness of data.
• Collaborate with teams to design and implement data management solutions.
• Conduct data validation and quality assurance activities to ensure data integrity.
• Develop and maintain documentation of data management processes.
• Demonstrated attention to detail, consistently meeting established quality standards.

• 1+ year of experience in medical claims adjudication, claims auditing, or encounter submissions.
• Ability to accurately resolve claims issues and meet established deadlines.
• 1+ year of experience conducting root cause analysis and implementing resolutions.
• 1+ year of experience documenting processes, procedures, and findings accurately and thoroughly.

Bachelor's degree in business, Finance, Accounting, Operations or other related fields

Experience identifying, researching, and resolving Medicaid claims and encounter data errors

Prior health insurance industry experience

Working knowledge of Microsoft SQL or SAS

• WAH 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 25x10 (25mpbs download x 10mpbs 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.

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, 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 should anticipate this interview to take approximately 10‑15 minutes.

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$65,000 - $88,600 per year

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

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, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities.

Final date to receive applications: 07-07-2026

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our Center Well healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities rn more about what we offer at  and at

It is the policy of Humana not to discriminate against any employee or applicant…