United States · Remote OK
$40k–$52k/yr
Become a part of our caring community As a Care Management Support Assistant, you will help members take the next step toward better health and well-being. You will do this by connecting with them over the phone, complet…
Skills: Call center operations, Inbound calls, Outbound calls, Customer service, Data documentation
Chicago, Illinois, United States · Hybrid
$86k–$119k/yr
Become a part of our caring community Humana's Corporate Strategy team is a small, collaborative and goal-focused group that works with senior leadership to establish the future course for Humana. In Corporate Strategy, …
Skills: Market research, Competitive analysis, Quantitative modeling, Financial modeling, Strategic planning
United States · Remote OK
$115k–$158k/yr
Become a part of our caring community The Lead Product Owner is responsible for translating product strategy and regulatory requirements into actionable work for Agile delivery teams supporting Humana's Interoperability …
Skills: Product ownership, Agile methodologies, Scrum, Healthcare interoperability, API management
United States · Remote OK
$71k–$98k/yr
Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider di…
Skills: Inpatient Medical Coding, Coding Auditing, ICD-10-CM, ICD-10-PCS, DRG Assignment
United States · Remote OK
$104k–$143k/yr
Become a part of our caring community The Service Fund Value Based Programs Lead develops, manages, and delivers strategic programs designed to support business objectives, operational effectiveness, and continuous proce…
Skills: Value-based care, Program management, Strategic planning, Process improvement, Stakeholder management
United States · Remote OK
$115k–$158k/yr
Become a part of our caring community The Compliance Lead (Pharmacy) ensures compliance with governmental requirements. You will work within specific guidelines and procedures; apply advanced technical knowledge to solve…
Skills: Pharmacy compliance, Medicare Part D, Medicare Part B, Risk management, Managed care
Washington, District of Columbia, United States · Remote OK
$129k–$178k/yr
Become a part of our caring community (remote in location) The Lead Intelligence Data Architect serves as the subject matter expert and functional owner for how Humana's cyber threat intelligence is collected, organized,…
Skills: Cyber threat intelligence, Data architecture, Anomali ThreatStream, Threat intelligence platforms, API integration
Corpus Christi, Texas, United States · On-site
$77k–$106k/yr
Become a part of our caring community Professional member of patient’s treatment team who provides skilled nursing visits in patient’s home under the direction of plan of treatment stablished with physician and input fro…
Skills: Registered nursing, Home health care, Patient assessment, OASIS data collection, Care plan development
Wisconsin, United States · Remote OK
$59k–$81k/yr
Become a part of our caring community Join Humana's Wisconsin Medicaid team as a Grievances and Appeals Professional and make a meaningful impact in the lives of our members. Reporting to the Manager of Consumer Engageme…
Skills: Grievance resolution, Appeals processing, Clinical documentation review, Conflict resolution, Mediation
United States · Remote OK
$118k–$162k/yr
Become a part of our caring community We are looking for a Senior Data Scientist to design and deliver Generative AI applications as part of the Growth Analytics & AI team. You will focus on building innovative, scal…
Skills: Generative AI, LLM, Python, Natural Language Processing, Prompt Engineering
Washington, District of Columbia, United States · Hybrid
$107k–$147k/yr
Become a part of our caring community The Sr Full Stack Software Engineer is responsible for producing scalable software solutions utilizing a range of different technologies and languages (such as Java, JavaScript, HTML…
Skills: Java, JavaScript, HTML, PHP, C#
Kentucky, United States · Remote OK
$48k–$66k/yr
Become a part of our caring community The Grievances & Appeals Representative 4 (Thursday-Monday shift) is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action …
Skills: Grievance and appeals, Clinical documentation review, Data entry, Outlook, Excel
Hickory, North Carolina, United States · Hybrid
$71k–$98k/yr
Become a part of our caring community At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members d…
Skills: Care Coordination, Patient Assessment, Discharge Planning, Acute Care Nursing, Case Management
United States · Remote OK
$224k–$313k/yr
Become a part of our caring community The Medical Director is responsible for Medicaid care strategy and/or operations. The Medical Director work assignments involve moderately complex to complex issues where the analysi…
Skills: Medicaid care strategy, Utilization management, Case management, Clinical decision making, Regulatory compliance
Rome, Georgia, United States · Hybrid
$71k–$98k/yr
Become a part of our caring community At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members d…
Skills: Care coordination, Acute care nursing, Discharge planning, Patient assessment, Clinical documentation
Evansville, Indiana, United States · Hybrid
$71k–$98k/yr
Become a part of our caring community At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members d…
Skills: Care coordination, Acute care nursing, Discharge planning, Patient assessment, Clinical documentation
Miramar, Florida, United States · Hybrid
$39k–$49k/yr
Become a part of our caring community Job Description Work Schedule: Full-time/40 Hours Position Type: Hybrid Branch Location: Miramar, FL The Intake Coordinator reviews new cases and calls patients to verify demographic…
Skills: Customer service, Microsoft Office Suite, Data entry, Insurance verification, Case management
Illinois, United States · Remote OK
$54k–$73k/yr
Become a part of our caring community The Care Coach evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resource…
Skills: Care coaching, Wellness coordination, Bilingual, Case management, Electronic health records
Wisconsin, United States · Remote OK
$59k–$70k/yr
Become a part of our caring community Join our team in this exciting role as Residential Adult Family Home (AFH) Certifier. Reporting to the Supervisor of Provider Engagement, you will oversee the certification of new an…
Skills: Certification, Compliance, Medicaid standards, Provider engagement, Documentation
Washington, District of Columbia, United States · On-site
$86k–$119k/yr
Become a part of our caring community The In-Office Provider Programs organization within Risk Adjustment delivers products that help physicians provide optimal patient care and improve the accuracy of clinical documenta…
Skills: Program delivery, Business process improvement, Data analysis, Operational performance, Compliance
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Engage members via phone to conduct non-clinical assessments, identify health barriers, and assist with scheduling appointments or accessing benefits. Manage inbound and outbound calls in an auto-dialer environment while maintaining detailed documentation of member information.
Requires at least one year of experience managing high-volume inbound and outbound calls and meeting performance metrics. Candidates must be proficient in Microsoft Office applications and capable of working a scheduled 8-hour shift within the specified EST timeframe.
Engage members by phone to encourage participation in care management programs.
Complete required assessments and questionnaires to help identify health risks, care needs, and opportunities for clinical team follow-up.
Assist members who need support scheduling doctor’s appointments or connecting with appropriate care resources.
Identify and help address barriers to preventive screenings, benefits, and health-related services so members can close gaps in care.
Support members in understanding, retaining, and accessing benefits that contribute to their overall health and well-being.
Manage both inbound and outbound calls in an auto-dialer environment while documenting member information.
You create a positive member experience by treating each interaction with respect, patience, and professionalism
You demonstrate compassion, integrity, and sound judgment when supporting members with sensitive health-related needs
You listen to understand member needs, ask appropriate follow-up questions, and solve problems within established guidelines
You stay up to date with department guidelines and apply training, tools, and procedures in your daily work
You work independently, manage your time, and ask for guidance when clarification is needed
You remain flexible and focused while adapting to changing healthcare priorities, member needs, and business processes
Call center hours of operation are Monday-Friday between 8:00 am and 8:00 pm EST
The assigned shift for this opportunity will be: 11:30 am – 8:00 pm EST
During the first 2 weeks of training, hours will be 8:30 am to 5:00 pm EST
We offer extended hours when needs arise. This could include occasional mandatory overtime to include evenings and weekends.
Minimum of 1 year of experience managing high-volume inbound and outbound calls
Experience meeting documented productivity, quality, or service performance metrics
Experience navigating, documenting, and updating member or customer information across multiple applications, programs, and platforms
Experience using Microsoft Word, Excel, Teams, and Outlook to complete daily work tasks, manage communications, track information, and maintain accurate documentation
Ability to work a scheduled 8-hour shift, including a 30-minute lunch, between 11:30 AM and 8:00 PM EST as assigned
Additional Information
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Text Prescreen: Shortly after submitting your application, you may receive both a text message and email requesting you to complete prescreen questions with either yes or no answers. The text message may arrive prior to the email. If you prefer to answer via computer or tablet, wait for the email.
Video Prescreen: If you are successful with the text prescreen, you will receive another communication to record a Video Prescreen. This is an online video activity using your phone, tablet, or computer; however, most candidates prefer using a computer or tablet.
Interviews: Some candidates will be invited to interview. If so, the recruiter will send an invitation through Hire Vue to schedule a day and time.
Offers: Finalists from the interview will be contacted by a recruiter to discuss the offer and benefits for the job
Note: Depending on the number of openings, the number of candidates who apply, and the schedules of interviewers and recruiters, this process may take several weeks or less; however, know that we are working hard to proceed as quickly as possible and to keep you informed.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact [email protected] to validate the request At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Offices: 500 W Main St, Louisville, Kentucky, US · 550 W Adams St, Chicago, IL 60661, US
Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact [email protected] to validate the request At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Offices: 500 W Main St, Louisville, Kentucky, US · 550 W Adams St, Chicago, IL 60661, US
