[Remote] Sr. Program Delivery Professional, G&A at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's degree or equivalent years of experience
5+ years in member/provider grievance management
Strong knowledge of Microsoft Office (Word, Excel, Access)
Excellent communication, both oral and written
Passion for contributing to an organization focused on continuously improving consumer experiences
Ability to work in a remote environment with minimal interruptions to protect member PHI / HIPAA information

Responsibilities

Lead daily management of grievance and complaint queues in PPCM, ensuring timely resolution per CMS SLAs
Coordinate with internal teams and external vendors to uphold best practices and contractual obligations
Manage additional feedback from Stars vendors (~150 pieces weekly)
Support highly regulated processes, including Privacy concerns, Quality of Care issues, and MRA delete management
Analyze feedback trends, communicate findings, and influence strategy for continuous improvement

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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