Humana

Senior Consumer Service Operations Professional

Kentucky, United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries

Requirements

Candidates must have prior experience working in the healthcare industry and at least 2 years of experience with Employer/Group Medicare plans. Extensive experience in a corporate service operations environment is required, along with a demonstrated ability to analyze information, research problems, and implement solutions. The role demands the ability to multi-task in a fast-paced environment, strong written and verbal communication skills including presentation abilities, and excellent interpersonal skills for developing collaborative relationships. Consultative skills, including assessing consumer needs and making recommendations, are essential. A comprehensive knowledge of Microsoft Office Suite (Word & Excel) and strong technical experience navigating multiple systems are necessary. The ability to travel up to 15% within the US is also a requirement. A Bachelor's degree, PowerPoint and Access skills, organizational skills, experience with medical claims and Medicare, and project management experience are preferred.

Responsibilities

The Senior Consumer Service Operations Professional is responsible for overseeing daily activities across multiple service functions areas, handling moderately complex to complex issues that require in-depth evaluation. This role may involve installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. The professional will investigate and settle claims and customer service issues, understand department, segment, and organizational strategy, and make decisions regarding work methods with minimal direction. All responsibilities must be performed onsite at the Public Education Employees Health Insurance Plan in Frankfort, Ky.

Skills

Healthcare industry
Employer/Group Medicare plans
Corporate service operations
Information analysis
Problem research
Solution implementation
Multi-tasking
Fast-paced environment
Written communication
Verbal communication
Presentation skills
Interpersonal skills
Collaborative working
Consultative skills
Consumer assessment
Independent work

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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