[Remote] Provider Engagement Professional at Humana

South Carolina, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

5+ years of Health care or managed care experience working with providers
Proven planning, preparation and presenting skills
Demonstrated ability to manage multiple projects and meet deadlines
Must reside in South Carolina
Position is field-based in South Carolina and requires travel to provider practices
Valid state driver's license and personal vehicle liability insurance

Responsibilities

Function as the first point of contact for provider issue resolution
Identify problems, provide solutions and resolve promptly
Serve as a liaison between Humana Healthy Horizons and the provider community
Provide the highest level of customer service to current or prospective providers
Attend all JOCs and related meetings for assigned region/providers
Develop and maintain provider relationships to optimize provider experience and satisfaction
Ensure prompt resolution of provider inquiries, concerns, problems or disputes
Communicate Humana’s policies and procedures and provider training/orientation materials
Coordinate provider training and provider orientation sessions
Plan and facilitate contractual provider trainings on an annual basis
Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues
Work with internal resources and systems to provide the Perfect Experience in all provider interactions
Ensure compliance with managed care contractual requirements for provider relations
Manage confidential client information with discretion and good judgement

Skills

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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