Lead-Medicaid Customer Success

San Antonio, Texas, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, MedicaidIndustries

Requirements

Candidates must have 3-5 years of experience with PBM operations and 3-5 years managing large-scale projects and cross-functional teams. A proven ability to develop working relationships within a highly matrixed business environment and to analyze data to make informed recommendations is essential. Passion for improving consumer experiences is also required. A Bachelor's degree and experience responding to government solicitations or developing stakeholder relationships are preferred.

Responsibilities

The Lead - Medicaid Customer Success will oversee strategy and operations for multiple Medicaid markets, ensuring compliance with client contracts and identifying opportunities for program improvements. This role involves partnering with market and government affairs teams to define state strategies, performing cost-benefit analysis, managing client relationships, and monitoring regulatory changes to provide strategic recommendations. Responsibilities include creating strong internal partnerships, improving member experience and profitability, managing the product lifecycle, streamlining issue management, monitoring plan performance, supporting new business implementations, driving project development, creating monthly business reviews, and resolving escalated member, client, and pharmacy issues.

Skills

Medicaid

Customer Success

Strategy

Operations

Client Contracts

Program Improvement

Member Experience

Cost-Benefit Analysis

Client Relationship Management

Regulatory Analysis

Strategic Recommendations

Business Development

Product Lifecycle Management

Issue Management

Project Management

Data Analysis

Pharmacy Trends

Pharmacy Utilization

Pharmacy Spend

Business Reviews

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.

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