Jobs in Nationwide

Become a part of our caring community The Counsel provides a full range of legal advice and services on litigation, arbitration, and related legal matters and strategy. The Counsel will collaborate internally and with outside counsel on case strategy, discovery, and resolution of disputes. The Counsel will exercise independent judgment and decision-making on litigation issues and related tasks and work under modest supervision. This role requires applying in-depth and broad knowledge of litigation practices, frequently taking full ownership of legal matters, and organizing and managing individual litigation matters from inception through trial. Use your skills to make an impact Required Qualifications Juris Doctor degree from an ABA-accredited law school Active and licensed membership in a state bar association At least 4 years of experience in litigation Strong project management and organizational skills across all facets of litigation from inception through trial Ability to organize and successfully manage a number of case matters simultaneously Strong skills in communicating complex legal issues to various stakeholders Ability to mitigate risk by acting as a trusted advisor whose strategic thinking, pragmatic problem-solving, and proactive counsel are sought by clients Ability to work independently under general supervision and in team settings Experience with large-scale e-discovery Preferred Qualifications Experience with provider disputes and healthcare reimbursement disputes Experience with alternative dispute resolution (ADR), including arbitration Understanding of Medicaid/Medicare laws and regulations Work at Home Requirements:

Become a part of our caring community The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight. Use your skills to make an impact Required Qualifications Minimum of 2 years of provider relations experience, healthcare services or related experience Minimum of 1 year of experience managing mid to large scale projects Intermediate experience in Microsoft Word, Outlook, Excel (VLOOKUP’s, lateral lookups & ability to manipulate data) and TEAMS Ability to accommodate a work schedule following Central Standard Time zone hours Preferred Qualifications Advanced experience with Microsoft Excel Provider contract interpretation experience Previous account management or project management Knowledge of medical claims Work at Home Requirements: To ensure Home or Hy

Become a part of our caring community The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Regulatory Compliance – State Enterprise Intake and Implementation – Senior Compliance Professional The Senior Compliance Professional implements new statues, regulations, rules and other regulatory guidance issued by state and federal regulators across the enterprise. Coordinates business partner engagement and implementation of rules. Researches compliance issues and recommends changes that ensure compliance with regulatory obligations. Provides compliance guidance and direction to business partners. Monitors metrics and other oversight tools that track implementation activity. Recommends new measures of compliance performance. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding implementation components. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Compliance Professional's primary focus will be to implement new federal and state rules, including PBM, across the enterprise. Key responsibilities may include: Serve as the subject matter expert and point-of-contact for individual state and federal implementations, leading implementation activity from onset to conclusion. Research, understand, and apply laws, regulations, and regulatory guidance for federal and state compliance issues. Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associate and leaders with regard to federal

Become a part of our caring community Humana’s Product organization is seeking a Lead Product Manager to drive the strategy, development, and optimization of the Adobe Experience Platform (AEP) in support of Adobe Web Integrations for Authenticated and Unauthenticated Web Channels. In this role, you will serve as a key product leader responsible for translating business needs into platform capabilities that enable personalized, data-driven customer experiences. You’ll work closely with cross-functional teams to deliver scalable solutions across Real-Time CDP, Journey Optimizer, and Customer Journey Analytics. This role is focused on growing adoption and usage of Adobe Experience Platform as an enterprise platform while supporting and scaling capabilities to support Authenticated (MyH) and Unauthenticated ( H.com) driving dynamic, context-aware customer engagement on Web channels. Success in this role means partnering with key lines of business to translate requirements into detailed product features for engineering teams to enable, while building decisioning strategies that optimize customer outcomes and business value. Key Role Functions Product Strategy & Vision Collaboratively own and manage the product backlo

Become a part of our caring community Provides executive leadership to Humana. The Regional Chief Medical Officer (CMO) is an entrepreneurial & experienced physician leader committed to the principles of comprehensive primary care and unlocking the power of value-based care for patients at national scale. S/he will be a proven clinician, leader, and strategist capable of driving the highest standards of care, building high-performance care teams, developing clinical leadership talent, and quantifiably improving outcomes and performance across multiple geographies. The Regional CMO will directly lead a team of regional & area medical directors and serve as dyad partner to the Regional Market President for one of the Primary Care Organization’s regions across the nation where CenterWell and/or Conviva serve patients. The Regional CMO will report to the Chief Medical Officer of the Primary Care Organization. This role requires periodic travel to markets (40% or less) to meet with national and regional teams and should be based in one of our current or upcoming CenterWell or Conviva markets. Responsibilities Drive Clinical Excellence in Culture & Performance · Build a best-in-class culture of engaged clinicians, focused on patient-focused care and clinical excellence, where doing the right thing for patients and team-based care within a value-based care framework, drives success and pride · Drive patient outcomes and population impact across regions for optimal results, across patient care experience & engagement, disease prevalence, quality/STARS, efficiency of care, and improved clinical outcomes and utilization. · Identify and act on opportunities

Become a part of our caring community Humana is looking for Inbound Contacts Representatives to be a part of our Provider Call Center; you are often the first human connection our members have with us. Working remotely, you will report to the Inbound Contacts Supervisor and be a part of the Medicare team. Every interaction is an opportunity to solve a problem, reduce frustration, and create trust. You will support members and providers by answering benefit questions, resolving concerns, and guiding them through next steps, helping ensure they feel informed and supported. This role is ideal for someone who enjoys helping others and takes pride in delivering a high-quality customer experience. As an Inbound Contacts Representative 2, you will: Handle 40+ inbound calls daily from providers in a back-to-back call center environment Address multiple members and provider needs, including benefit questions, service issues, and general inquiries Escalate unresolved and pending customer grievances Document all interactions, actions taken, and outcomes in internal systems Resolve routine to moderately complex issues by following established guidelines and workflows Identify issues requiring escalation and ensure handoff to the appropriate teams Meet quality, productivity, and customer experience expectations What Success Is: Providers feel heard, supported, and satisfied with their experience You are proactive and resolve issues on the first contact whenever possible Documentation is complete, clear, and compliant Experience empathizing with frustrated customers, and accountability in every interaction Use your skills to make an impact Required: 2+ years of Customer Service experie