Description

The Senior Consumer Service Operations Professional is responsible for the daily activities across multiple service functions area. The Senior Consumer Service Operations Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Where you Come In

Are you interested in working in a fast paced operational environment? Do you like to stay busy and learn new skills every day? If so, this is the role for you! The Consumer Service Operations role is responsible for working inquiries from multiple service areas and supporting provider installation quality outcomes. The Senior Consumer Service Operations Professional work assignments are complex in nature, performing in depth analysis of data and workflow scenarios, incorporating the evaluation of varying factors to achieve resolution. Some daily duties include; performing research, issue resolution, provider and market support, claims review and participation in project/initiative implementations.

In addition, the Consumer Service Operations role within PCL is responsible for providing strategic and tactical solutions to acute issues and promote improvement opportunities. Multiple tools and forums will be utilized such as, but not limited to, IMS PCL Intakes, Zync, CRM, and market collaboration forums. The role will function as an expert on PCL processes and policies, provider setup and systems such as, APEX, PAAG & PMDM.

The Consumer Service Operations role keeps the provider and member in mind as they conduct business. The end goal is to help ensure a positive provider and member experience as it pertains to ensuring accurate and timely provider installation.

Role Responsibilities
• Resolve Provider Installation issues submitted through various tools and formats such as IMS PCL Intakes, CRM and PCP Database.
• Function as an expert on PCL processes and policies, provider setup, and systems such as PAAG, PMDM, CAS & MTV.
• Conduct research as needed related to issues such as, but not limited to, Executive Inquires, DOI complaints and G&A escalations.
• Complete required audits including, Peer Reviews, Pre Load and Post Load audits and CMS Finance Audits
• Conduct monthly Collaboration Calls with assigned market to present data sets illustrating trends related to submissions, routes, rejects and pertinent contract loading topics.
• Drive automation opportunities for loads with groups of 25 or more physicians.

What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed

• Bachelor's degree or 3 years of Provider Contract Load experience
• Minimum of 5 years of experience in a metric based environment
• Proficient with MS Excel and PowerPoint
• Strong analytical skills and creative problem-solving ability
• Strong data analysis skills
• Ability to manage multiple or competing priorities and work in a very fast-paced environment
• Strong written and verbal communication skills
• Excellent interpersonal skills and ability to develop collaborative working relationships across multiple functional areas in the organization
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Must commit to working within the department for minimum of eighteen (18) months
• Must be within 90 minutes of Louisville or Green Bay office
• For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
• If progressed to offer, you will be required to:
• Provide proof of full vaccination OR
• Commit to weekly testing, following all CDC protocols, OR
• Provide documentation for a medical or religious exemption consideration.
• This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

• High school diploma, GED or job certification required
• M.B.A., C.P.A. or advanced degree in healthcare
• Project Management Professional (PMP) certification
• Six Sigma certification
• Proficient with MS Access, Visio and Project
• Knowledge of CMS Medicare manuals for research and reporting criteria and audit protocols

Additional Information - How we Value You

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Go365 perks for well-being

Work-At-Home Requirements
• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers 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 next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40