[Remote] Senior Provider Relations Professional at Humana

Michigan, United States

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

3+ years of healthcare or managed care experience working with providers
Experience with Michigan Medicaid
Knowledge of Microsoft Office applications
Demonstrated ability to manage multiple projects and meet deadlines
Exceptional relationship management skills
Experience handling escalated provider complaints/issues
Understanding of health insurance claims and data analysis
Excellent written and verbal communication skills
Proficiency in analyzing and communicating complex issues
Exceptional time management and ability to manage multiple priorities
Must be located in or willing to relocate to the Metro Detroit area
Valid driver’s license with reliable transportation and the ability to travel within the state

Responsibilities

Foster positive, long-term relationships with network providers
Manage onboarding and orientations for new providers
Conduct ongoing education and training for providers on self-service functions
Schedule, prepare, and facilitate Joint Operating Committee or other provider meetings
Ensure prompt resolution of provider inquiries, concerns, or problems
Create and/or deliver trainings and educational materials for providers
Participate and/or speak at Town Halls, webinars, or other forums to communicate policy updates
Ensure compliance with Michigan managed care contractual requirements for provider relations
Schedule, prepare, and complete on-site provider location visits
Obtain and relay accurate credentialing documents to the credentialing team
Use skills to make an impact

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.

Land your dream remote job 3x faster with AI

Try Jobo Free