[Remote] Accreditation Professional at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

  • Bachelor's degree
  • 1+ year of experience in process improvement, data analytics, Compliance, Risk Management, and/or program implementation/design
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, PowerPoint, and Teams
  • Demonstrated excellent time management skills with proven ability to be flexible, adapt to changing environment, handle multiple tasks and deadlines and manage multiple priorities
  • Exceptional verbal and written communication skills
  • Passionate about contributing to an organization focused on continuously improving consumer experiences
  • Desire to develop in-depth knowledge of the NCQA accreditation process and standards
  • Preferred Qualifications
  • Previous experience working in a managed care field
  • Accreditation experience or experience in operational areas subject to accreditation requirements (such as utilization management, case management, credentialing, network operations, quality)
  • Previous experience working with AI
  • SharePoint and Smartsheet experience

Responsibilities

  • Manage a variety of tasks related to the administration of the NCQA accreditation survey process
  • Prepare and load documents into NCQA’s online submission tool
  • Coordinate document reviews with multiple stakeholders
  • Schedule key meetings and audits
  • Organize team documentation and archive
  • Support management of large-scale NCQA governance committee by building newsletters and taking meeting minutes
  • Assist in document review of member handbooks and provider manuals to ensure NCQA compliance
  • Support leadership in developing AI capabilities for accreditation work
  • Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
  • Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction

Skills

NCQA accreditation
process improvement
data analytics
Compliance
Risk Management
program implementation
Microsoft Office
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Teams
time management
verbal communication
written communication

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI