Job Information
Humana Director, Consumer Service Operations in Lansing, Michigan
Become a part of our caring community and help us put health first
Become a part of our dynamic Wisconsin leadership team in this position as the Director, Consumer Service Operations. This position works with insurance companies, providers, members, and collection services in the settlement of claims through Call Center operations. Comprised of a team of claims associates researching & resolving the resolution to a claim inquiry; Service center associates for Provider and Member calls; enrollment and configuration activities; and oversight of multiple TPA vendors that support the technology and BPO. Oversees a departmental budget for cost controls and efficiency and supports annual claims payments of over $1B through partnering with finance controllers. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
The Director, Consumer Service Operations may perform installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Investigates and settles claims and customer service issues. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.
Focus on improvement initiatives directed on delivering improved performance rates and optimal customer experiences
Must be able to take complex problems and distill into manageable pieces to develop solutions
Create/Maintain collaborative working relationships with partners across the enterprise, in effort to create streamlined processes and improved provider/member experience
Oversee performance oversight and roadmap toward operational excellence for MCD Strategy & Relationship management
Responsible for performance monitoring and operational reporting in the Special Projects Front End & Claims Processing space, with regular executive summary roll-up to leadership
Drive engagement efforts with Network Operations & Market partners, to ensure consistent identification of opportunities and best practices for improvement
Identify and monitor rework drivers, implement practices to eliminate rework of rework, establish robust audit practices on complex projects
Oversight of Humana’s WI Market shared service functions; Business Configuration, Claims, Customer Service, Enrollment and Provider Engagement departments for Medicare and Medicaid lines of business. Would need to be expanded to include the Inclusa areas.
Relationship manager for 3rd Party vendors including claims processing, claim payment, post payment, clinical editing software and fulfillment functions; with clear oversight, performance reporting and strategic objectives.
Drive key business indicators in WI Market that support contract and regulatory requirements; CMS audits, HEDIS measures, NCQA Accreditation, Compliance standards and Financial Trends
Utilizes reporting and performs detailed data analysis to identify financial trends, cost saving measures and create operational efficiencies
Provide strategic support for departmental, WI Market and enterprise wide initiatives and objectives promoting growth, compliance and innovation.
Encourages communication amongst operational business units and fosters cross collaboration with all departmental partnerships
Develop associate talent and performs recession planning activities to support continued growth of the WI Operations department.
Develops strategic roadmap to ensure proper resource allocation, oversight and goal alignment
Provides clear visibility into departmental oversight, metrics, compliance risk, etc., driving key recommendations to promote company wide goals and mission statements
Support all integration activities, including but not limited to sharing operational expertise, supporting system optimizations, participating in governance committees and navigating change management activities.
Use your skills to make an impact
Required Qualifications
Bachelor's Degree
5 or more years of technical/operational experience in Claims or Service Operations
5 or more years of management experience
Experience with vetting/implementing software programs/tools
Progressive experience in the health solutions industry, with emphasis on leading and managing teams
Experience with decision making for large scale projects or new/updated programs
Proficiency in analyzing and interpreting data and trends
Strong attention to detail and focus on process and quality
Excellent communication skills
Ability to operate under tight deadlines
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs
Preferred Qualifications
Located in WI or within a boarding State
Prior Experience in Medicaid insurance setting
Strong understanding of Human Resource principles
Six Sigma or Lean experience
Additional Information
Workstyle: Home
Travel: Occasional travel- Quarterly
Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm CST
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Benefits
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:
Health benefits effective day 1
Paid time off, holidays, volunteer time and jury duty pay
Recognition pay
401(k) retirement savings plan with employer match
Tuition assistance
Scholarships for eligible dependents
Parental and caregiver leave
Employee charity matching program
Network Resource Groups (NRGs)
Career development opportunities
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
SSN Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.
Scheduled Weekly Hours
40
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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$138,900 - $191,000 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.
About Us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell 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, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.