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Humana

Sells Medicare health plans and runs senior clinics

Member Services Advisor

Customer ExperienceUpdated on Nov 15
Full-timeSouth Carolina, USA

About the Job

Requirements

  • Must reside in South Carolina.
  • Must be able to travel up to 10% to Columbia, South Carolina for business.
  • Must have 8 or more years of consumer operations experience.
  • Must have 2 or more years of people or project leadership experience.
  • Must be able to develop functional strategies to improve performance and consumer experience.
  • Must have experience identifying optimization and automation solutions to develop and launch company initiatives.
  • Must have experience with analytics, including program evaluation and optimization.
  • Must have strategic thinking and planning capabilities and be organized and detail-oriented.

Responsibilities

  • Develop and execute strategies to improve member engagement, retention, satisfaction, and overall experience while maintaining direct ownership of key market KPIs and performance metrics.
  • Lead the Member Experience Workgroup.
  • Drive Go365 engagement and utilization.
  • Oversee member benefits, services, and incentives.
  • Serve as the market point of contact for Member/Provider Services, Transformation, Enrollment, and G&A/Critical Inquiry teams.
  • Develop strategies to improve CAHPS survey performance.
  • Provide cross-functional leadership and drive measurable improvements in consumer experience outcomes and contractual performance.
  • Serve as a member advocate and coordinate communications with members.
  • Coordinate issues with appropriate areas within the organization.
  • Resolve member inquiries and problems while meeting standards for resolution, telephone abandonment rates, and telephone hold times.
  • Assist members in accessing culturally competent, high-quality integrated medical and behavioral health care.
  • Advise executives in developing functional strategies, often segment-specific, on matters of significance.

Desired Qualifications

  • A bachelor's degree is preferred.
  • A history of Clinical Program Valuation is preferred.
  • Knowledge of Humana's internal policies, procedures, and systems is preferred.

About the Company

Humana

Sells Medicare health plans and runs senior clinics

Humana sells health insurance paid for by government programs, chiefly Medicare Advantage plans that private insurers run for Americans 65 and older in place of traditional Medicare. It ranks among the largest Medicare Advantage insurers in the country and also runs Medicaid plans for low-income families in several states. Its CenterWell business operates senior primary care clinics, a mail-order pharmacy and home health services, so many members get care from a company the insurer owns. Medicare and states pay Humana a set monthly amount per member, and it keeps the difference between those payments and members' medical costs. Humana was founded in 1961 as a nursing home company and is based in Louisville, Kentucky.

Company size
10,001+
Company stage
IPO
Headquarters
Louisville, KY
Founded
1961

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