[Remote] Market Development Advisor at Humana

South Carolina, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a minimum of three years of experience in provider relations, engagement, communications, and/or health plan operations. A minimum of three years of experience with value-based contracting strategy/analysis and two years of process creation or improvement experience are also required. The role demands strategic thinking, strong problem-solving abilities, excellent interpersonal, organizational, written, and oral communication skills, and proficiency in MS Office applications including SharePoint, Teams, Word, PowerPoint, Outlook, and Excel. A Bachelor's or Master's degree and familiarity with SC Medicaid/government healthcare are preferred.

Responsibilities

The Market Development Advisor will provide support for Medicaid product implementation, operations, contract compliance, and federal contract applications. Key duties include advising on Provider Relations and Network Operations performance, driving network strategic initiatives, establishing infrastructure to measure KPIs, developing and managing the Provider Support Plan and state reporting, and overseeing provider communications and training. The advisor will also monitor performance against contractual commitments, perform root cause analysis for data inaccuracies, and facilitate workgroup calls to improve data accuracy and network strategy.

Skills

Medicaid product implementation

Operations support

Contract compliance

Federal contract application submissions

Provider Services

Strategic operations

Process development

Process improvement

Standardization

Efficiency

State reporting

Provider communication

Provider materials development

Market implementation

Cross-functional partnership

Independent judgment

Analysis

Provider Relations

Provider Engagement

Network Operations

Network strategic initiatives

Tactical execution

KPI measurement

Managed care contractual requirements

Provider Support Plan

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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