Note: The job is a remote job and is open to candidates in USA. Humana is a leading U.S. healthcare company, and they are seeking a Senior Market Development Professional to support Kentucky Medicaid product implementation and operations. The role involves overseeing market compliance, driving process improvements, and coordinating data analysis to enhance operational efficiencies.
Responsibilities
- Market oversight and monitoring of required contractual processes. Initiate escalation/tickets with business areas/workstreams for analysis and correction. Provide regulatory, contractual and procedural guidance
- Document, maintain, and improve core Market Operations processes; update procedures as needed and support implementation of new projects
- Interpret regulatory/operational data and partner with Data & Reporting to produce insights that inform market strategy and leadership decisions
- Coordinate meetings, manage deliverables, and track implementation of cost-saving initiatives
- Track market oversight activities and drive closure of compliance actions and process improvements
- Develop agendas, coordinate KMOO sessions, and manage post-meeting action items focused on compliance, trends, and consumer experience
- Support Consumer Experience Professional 2 by coordinating assignments and implementing process improvements from call listening sessions
- Coordinate communications and operational changes with vendor management professionals to ensure vendor compliance with Health plan and vendor contract. Ensures implementation of program updates and member/provider communications coordinating through vendor management professionals
- Ensure alignment between regulatory reports and the KDMS Operations Insights Dashboard for accuracy and transparency
- Maintain the Plan Resource Manual (contacts and processes) to support market execution
Skills
- Bachelor's degree
- 5 or more years of experience in an insurance or health care setting
- 2 or more years experience interpreting regulations and contracts
- Demonstrated experience implementing and measuring outcomes for complex health-related initiatives/pilots
- Strong relationship-management and stakeholder-influence skills
- Process improvement mindset; ability to document, standardize, and enhance operational workflows
- Commitment to improving consumer experience
- Master's Degree
- Medicaid experience
- PMP certification
- Six Sigma
- Proficient with Microsoft office products
Benefits
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
- Medical, dental and vision benefits
- Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
Company Overview
Company H1B Sponsorship