Consumer Experience Lead - Illinois Medicaid Market

Employment Type: Full-time

Position Overview

Humana Gold Plus Integrated is seeking a dedicated full-time Consumer Experience Lead for the Illinois Medicaid Market. This role is crucial for enhancing member services by leveraging customer insights, root cause analysis, and member experience design. The Lead will identify and eliminate friction points, optimize processes through automation, and empower the organization to champion improvements in the member experience.

Responsibilities

• Strategic Advising: Advise executives on functional strategies and lead the execution of initiatives related to member grievance and appeal trends, collaborating with cross-departmental management.
• Cross-Functional Partnership: Partner with various consumer services areas, including Consumer Experience, preventive and enhanced services, client support, client services, client administration, customer service, enrollment, and eligibility, to ensure excellence.
• Member Services Influence: Influence member services activities such as helpline performance, email communications, member education, website experience, outreach programs, and the development and distribution of member materials.
• Grievance and Appeal Resolution: Work closely with managers (Quality Manager, Utilization Manager, Medical Director) and other departments to address and resolve member grievances and appeals.
• Enrollment Broker Interface: Oversee the interface with the Enrollment Broker on issues related to member enrollment, disenrollment, PMP assignments and changes, and member eligibility.
• Training and Orientation: Ensure the delivery of orientation and ongoing training for member services helpline representatives to effectively inform members about Humana's operations, services, benefit plans, limitations, health screenings, emergency services, PMP assignments, specialty provider referrals, self-referral services, preventive and enhanced services, and grievance/appeal procedures.
• Contract Compliance: In coordination with key staff, ensure all member services operations comply with the terms of the Contract.

Requirements

• Must reside in the State of Illinois or be willing to relocate.
• Ability to travel throughout Illinois as needed for the role.
• Bachelor's degree.
• 5+ years of experience in call center operations or a related service operations environment.
• Prior experience with LTSS or program population.
• 3+ years of leadership and management experience with direct reports.
• 2+ years of project/program management experience.
• Knowledge and/or experience working with Medicaid or DSNP Members.
• Knowledge and/or experience working with grievance and appeals.
• Intermediate to advanced knowledge of Microsoft Office Suite (Word, Excel, PowerPoint, Visio).
• Demonstrated ability to generate and champion innovative strategies with leadership.
• Strong investigative, problem-solving, and analytical skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Experience working in a matrixed organization and influencing change.

Preferred Qualifications

• MBA or an equivalent degree.
• Experience with DSNP, Illinois, or other State Medicaid Managed Care Programs, specifically in Member/Consumer Experience areas.
• Experience with process improvement initiatives and strategy development.

Work at Home Requirements

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended.
• Wireless, wired cable, or DSL connection suggested.
• Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Associates residing and working from home in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.
• Humana will provide Home or Hybrid Home.