Become a part of our caring community and help us put health first

Humana Gold Plus Integrated is seeking a Consumer Experience Lead who is dedicated full-time to member services for the Illinois Medicaid Market. This Lead leverages the voice of the customer, root cause, telling the story, call listening, member experience design, elimination and recognition of friction points, identifying automation/optimization opportunities, and empowers others in the organization to speak up and voice opportunities to improve the member experience.

The Consumer Experience Lead roles and responsibilities include:

• Advises executives to develop functional strategies on matters of significance, and lead execution of member grievance and appeal trends, working closely with cross-departmental management.
• Partners across consumer services areas ensuring excellence with functions such as Consumer Experience, preventive and enhanced services, client support, client services, client administration, customer service, enrollment and eligibility.
• Influences member services activities, including, but not limited to, member helpline telephone performance, member e-mail communications, member education, the member website, member outreach programs, development, approval, and distribution of member materials.
• Works closely with other managers (especially the Quality Manager, Utilization Manager, and Medical Director) and departments to address and resolve member grievances and appeals.
• Oversees the interface with the Enrollment Broker regarding such issues as member enrollment and disenrollment, member PMP assignments and changes, and member eligibility.
• Ensures the delivery of orientation and ongoing training for member services helpline representatives to support accurately informing members of how Humana operates, availability of covered services, benefit plans and limitations, health screenings, emergency services, PMP assignment and changes, specialty provider referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures
• In close coordination with other key staff, responsible for ensuring that all of Humana’s member services operations are compliant with the terms of the Contract.

Use your skills to make an impact

Required Qualifications

• Must live in the State of Illinois (or be willing to relocate) and be able to travel throughout Illinois as needed for role.
• Bachelor's degree.
• 5+ years of experience in call center operations or a related service operations environment.
• Prior experience with LTSS or program population.
• 3+ years of leadership and management experience with direct reports.
• 2+ years of project/program management experience.
• Knowledge and/or experience in working with Medicaid or DSNP Members.
• Knowledge and/or experience in working with grievance and appeals.
• Intermediate to advanced knowledge of Microsoft Office Suite specifically in Word, Excel, PowerPoint and Visio.
• Demonstrated ability to generate and champion innovative strategies with leadership.
• Strong investigative, problem-solving and analytical skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Experience working in a matrixed organization and influencing change and direction.

Preferred Qualifications

• MBA or an equivalent degree.
• Experience with DSNP, Illinois or other State Medicaid Managed Care Programs, specifically in Member/Consumer Experience areas.
• Experience with process improvement initiatives and strategy development.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided with a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information

• Direct Reports: Up to five associates.
• Workstyle: Remote – work at home; must live in the State of Illinois.
• Travel: Up to 5% travel in the state of Illinois.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday Central Standard Time (CST) with flexible scheduling (i.e. occasional nights and weekends).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....

Interview Format

As part of our hiring process, we will be using exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$104,000 - $143,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.