BlueCross BlueShield of South Carolina jobs in Columbia, SC

Responsible for daily workflow activities to include the following membership/enrollment activities: processing of applications for new enrollments, terminations/cancellations, changes, renewals, and database updates. Description Logistics: This is a full-time (40-hours/week) position, Monday-Friday in office environment. Employees will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. This position is located at 17 Technology Circle, Columbia, SC 29229 What You Will Do: Receives and logs subscriber and member enrollment applications to the system. Processes/keys applications including new enrollments, terminations/cancellations, changes, and renewals and updates all electronic enrollment files. Works edit/error reports generated from membership transactions. Works with multiple operational areas to ensure relevant/appropriate group structure, status, benefits, and/or billing. May prepare and issue contracts, benefit books, and standard/custom ID cards. Responds to and resolves customer inquiries. Contacts plan administrators and internal and external customers to resolve issues/problems. Participates in special projects assigned related to enrollment, billing and reconciliations. To Qualify for This Position, You'll Need: Required Education: High School Diploma or equivalent. Required Skills and Abilities: Ability to acquire knowledge of the membership system. Working knowledge of word processing and spreadsheet software. Good judgment. Effective customer service and organizational skills. Demonstrated verbal and written communication skills. Basic business math proficiency. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Other Tools: Microsoft Office. We Prefer That You Have: Preferred Specialized Training: Data entry, office technology or secretarial science. Preferred Work Experience: One (1) year-of customer service, administrative/clerical support, and/or membership/billing/accounts experience. Preferred Skills and Abilities: Working knowledge of database software. Computer systems support knowledge. Knowledge of booklet ID card preparation, underwriting enrollment regulations, contract formats. Knowledge of state and federal laws related to private business types of insurance. Knowledge of standard benefit structures. Preferred Software and Other Tools: Working knowledge of Microsoft access. Work Environment: Typical office environment. Travel between office buildings. Moving/carrying of boxes/materials. What We Can Do for You: We understand the value of a diverse and inclusive workplace. We strive to be an employer across all spectrums where employees can develop their skills, advance their careers, and contribute their unique abilities to the growth of our company. Our comprehensive benefits package includes: Subsidized health plans, dental and vision coverage 401K retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Wellness program and healthy lifestyle premium discount Tuition assistance Service recognition Employee Assistance Discounts to movies, theaters, zoos, theme parks and more What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Performs varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying, compiling records, filing, tabulating, posting information, and distributing mail. Applies knowledge of department policies and procedures, and utilizes a general understanding of other departments' functions to resolve most issues. Maintains records, prepares forms, verifies information and resolves routine problems. May assist in orienting and training others. Description Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 4101 Percival Road Columbia, SC 29229-8320. What You'll Do: Scan, images and indexes documents. Verify accuracy of data and corrects errors discovered during review or research of documents. Compare or research incoming mail or work requests to ensure related components are put together appropriately and free of errors and duplicates. Sort and distribute documentation appropriately. Prepare correspondence or packages for internal/external mailing. Track correspondence and/or packages and follows up as needed. Maintain departmental logs, spreadsheets or databases. May prepare basic reports/statistics for management on work received for production and workload assessment. Order supplies and maintains departmental supply inventory. Assist other staff members in related duties as needed. To Qualify for This Position, You'll Need: Required Education: High School Diploma or equivalent Required Work Experience: 2 years of clerical or office support experience Required Software and tools: Microsoft Office. Required Skills and Abilities: Good communication and organizational skills. Detail-oriented. Basic business math, computer skills Our comprehensive benefits package includes the following: 401(k) retirement savings plan with company match Fantastic health plans and free vision coverage Life insurance What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Become a part of our caring community and help us put health first The Center Administrator is a healthcare professional who leads the daily operations of our senior primary care centers and upholds our model of care that puts patients at the center of everything we do. The Center Administrator (CA) leverages strategic leadership to launch a new center or manage an existing center which has an established significant patient volume, revenue, and staff. Prioritizing team building, enhancing market presence, and developing comprehensive operational standards to ensure seamless operations, effective financial management, and high patient satisfaction. The CA develops and implements staffing plans, policies, and procedures, and collaborates with clinicians to achieve optimal patient outcomes and company initiatives, including Quality, HEDIS/STARs, AHCA, financial management, and employee and patient retention. Specific details may vary by market/center at the discretion of local leadership. KEY RESPONSIBILITIES Leadership & Operational/Organizational Management: * Oversee operations within a multi-physician office or clinical group, maintaining an owner-operator mindset and leading by example, while supervising and managing Medical Assistants (MA) and Front Office (FO) staff to promote a positive team culture, guide performance expectations, and manage daily schedules. * Ensure adherence to state and federal regulations. * Plan and execute staff meetings, demonstrating strong financial acumen and managing Profit & Loss (P&L) to connect strategy with business results. * Manage front-of-house and back-office operations, ensuring the center is clean, organized, and welcoming. * Manage center associates ensuring sufficient staff, onboarding new associates, including providers, and ongoing training and development * Conduct monthly meetings with Regional Associate Operations Director (AOD), Assistant Medical Directors (AMD), and providers. * Monitor and improve NPS Scores, providing explanations and conducting service recovery requests. * Foster effective collaboration and communication with colleagues, patients, and key stakeholders. * Provide assistance with administrative duties such as expense reporting, new provider hiring/onboarding, license/credentialing management, scheduling, etc. Clinical/Patient Management: * Commitment to creating patient-centric environments and fostering a culture of care and connection. * Deliver service excellence by prioritizing patient needs, ensuring high satisfaction, and including their perspectives in decision-making. * Address clinician performance issues and manage and resolve patient complaints, focusing on retention and acquisition. * Focus on patient outcomes and integrate Value-Based Care (VBC) principles into daily operations. * Conduct monthly safety audits, manage MSDS and OSHA concerns, and address clinic operation opportunities. * Collaborate with providers on patient terminations in compliance with regulations Dyad Partnership: * Collaborate with clinical dyad partners, meeting regularly to align on clinical and operational goals and building high-performing teams with clinical and operational staff. * Maintain regular communication to align on performance, strategies, and team management. * Ensure unified decision-making and consistent messaging for cohesive leadership. * Work together towards common goals that support the mission, vision, and values, along with overall patient experience outcomes. * Manage clinic/market dynamics and engagement interdependently. * Monitor and communicate incentive plans effectively. * Develop provider engagement strategy plan to mitigate turnover, improve provider satisfaction and burnout. Use your skills to make an impact Required Qualifications: * Must be able to work on-site at assigned Center(s). * 5+ years of operational leadership experience within a multi-physician office or clinical group, including front of house management and clinical operations, along with direct leadership experience and a demonstrated ability to lead, coach, and mentor teams. * Primary Care experience, full-risk VBC experience, understanding of state and federal healthcare regulations. * Experience with Electronic Medical Record (EMRs) or Health Information Management (HIMs) systems and knowledge of various software tools. * Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, community organizations and other health plan staff. * Job is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. Candidates selected for this job will be required to be screened for TB. * Candidates selected for this job will be required to adhere to Humana's flu vaccine policy. * Current CPR certification Associates working in the State of Florida will need ACHA Level II Background clearance. Preferred Qualifications: * Bachelor's degree, preferably in Business Administration, Healthcare Administration, or a related field; or, in lieu of a bachelor's degree, 5+ years of Healthcare Administration/Leadership experience * Basic knowledge of Population Health Strategy * Familiarity with Medicare * Experience managing a budget of $500,000+ #LI-MD1 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. $71,100 - $97,800 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 About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. 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.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Position Purpose: Responsible for owning and overseeing the Contact Center's knowledge base (Genesys) and leading the Knowledge Management Shared Services team, which consists of Content Specialists. The Knowledge Manager works closely with Contact Center leadership to align knowledge management strategies with operational goals, ensuring agents have access to accurate and up-to-date information to support member/ provider inquiries. Additionally, the Knowledge Manager develops best practices for knowledge management, monitors the quality and performance of the knowledge base, and identifies opportunities for growth. Location: This position is full-time in a typical office setting and could potentially operate on a 3 day in office 2 day W@H schedule, located in Columbia, SC. Please note this is subject to change based on employee performance and/or business need. What You'll Do Supervises & manages members of the Knowledge team. This includes providing guidance on best practices for Knowledge Management, supporting the team with blockers, ensuring the team is following correct procedures when creating/ updating/ archiving articles, providing feedback to team members on a regular basis, identifying opportunities for growth, discussing career goals, and facilitating performance reviews. Sets Knowledge Management objectives, and is responsible for developing, updating, and monitoring key performance indicators related to Knowledge. This includes monitoring long-term trends and working with LOB leads to align on standards and goals. Identify opportunities to improve Knowledge Management processes and collaborate with other departments/appropriate leaders to implement changes to increase efficiency & effectiveness (e.g., opportunities for automation). Work with LOB leads to support with strategic planning for ongoing improvement. Works with Content Specialists and LOB leads to identify trends in the data and determine where additional knowledge can be created to solve for those gaps. To Qualify for This Position, You'll Need the Following: Required Education: Bachelor's in job related field. Degree Equivalency: Associates degree plus an extra 2 years job related work experience for a total of 7 years of required work experience (see "required work experience") OR 9 total years required work experience. Required Work Experience: 5 years of experience as a Content Specialist or in a relevant role, demonstrating thorough knowledge of managing a knowledge base & associated processes as well as and contact center standards of excellence. Required Skills and Abilities: Analytical Skills: Strong ability to identify gaps in current processes and a creative mindset to develop new processes or systems to increase efficiency. Communication Skills: Strong written and verbal communication skills to effectively communicate with leaders, team members, and other departments. Leadership experience: Ability to lead a team, identify opportunities for growth, and guide team members to improve their skills, providing constant feedback. Critical thinking skills: Ability to solve business problems and make informed decisions based on data and logic. Coaching Experience: Demonstrated ability to provide coaching and identify areas for improvement within individuals and the broader organization. Contact Center experience: General knowledge of business operations, objectives, strategies, processes, and information flow Required Software and Tools: Microsoft office. We Prefer That You Have the Following: Familiarity with knowledge management systems, content management tools, and collaboration platforms. Experience with Change management including the ability to drive adoption of knowledge management practices and tools. Ability to structure and maintain knowledge repositories. Strong understanding of taxonomy and metadata for easy retrieval. Understanding of AI-driven knowledge tools and automation. Skilled in training and onboarding employees to use KM systems effectively. Our comprehensive benefits package includes the following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose Responsible for moderately complex accounting activities relating to the maintenance of a complete and accurate general ledger and/or the resultant managerial reports and/or financial statements. Logistics: This is a full-time position, working a Hybrid schedule (3 days onsite and 2 days remote), located at 4101 Percival Road, Columbia, SC 29229. Due to requiring on-site attendance for a hybrid schedule, local candidates need apply. What You'll Do: Reconciles assigned general ledger accounts of routine to moderate complexity. Initiates and/or processes journal entries into various accounts. Performs reviews of various systems activities for Financial and/or Operational reporting, which may include upper-level review of co-workers or next level review. Prepares financial reports for financial analysis, forecasting, trending, budgeting, and/or results analysis to ensure transactions in the ledger tie to statistical files and/or various financial reports. Performs analyses of financial data to identify problem areas and/or report to management. Prepares supporting reports and/or spreadsheets required to prepare financial reports. Prepares spreadsheets for daily and/or monthly balancing and/or reconciling. Research and/or completes account reconciliations to maintain accurate general ledger accounts. Resolves out of balance situations and/or ensures outstanding items do not exceed standard timeframe. Maintains documentation of work papers including costing, invoicing, allocation and/or other required auditable documents. Assists with all audit preparation and/or review. Assists internal and/or external auditors. Assists supervisor with special projects. May assist in directing activities of staff or a function. To Qualify for This Position, You'll Need: Bachelor's in a job-related field with 24 semester hours in accounting. 2 years of accounting experience. Knows fundamental accounting concepts, practices and procedures. Possesses good communication, organizational and analytical skills. Ability to work independently. Microsoft Office. Ability to use data retrieval applications. What we Prefer you to have: Able to write queries using database software. Our Comprehensive Benefits Package Includes: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

**Become a part of our caring community and help us put health first** The Health Insurance Exchange Liaison is primarily focused on Humana's obligations, as a Qualified Dental Plan (QDP) issuer, to meet all federal Affordable Care Act (ACA) and state-based requirements to participate in their respective programs on the Federally-facilitated Exchange (FFE) and State Based Exchanges (SBEs). This position is responsible for gathering, reviewing, analyzing, and disseminating relevant participation requirements to internal and external partner teams charged with fulfilling those requirements and overseeing program requirements and deliverables to ensure Humana is compliant with these requirements year-over-year in accordance with federal and state-level timelines. This position will also interface with Humana Dental business leaders, including - but not limited to - actuarial, product strategy, product strategy advancement, and network, about the evolving footprint in accordance with Humana Dental's overall public exchange strategy. Health Insurance Exchange Liaison will be responsible for: **_Exchange Liaison_** + Establish and maintain effective communication and relationships with numerous Federal and State organizations in support of efforts to participate as a QDP with respect to Exchange operations and integration for Federal and State Based health insurance exchange platforms. + Research, review, analyze, and disseminate regulatory information and requirements to all associated internal teams to support Exchange operations and integration with the Federal and State Based health insurance exchange platforms. + Serve as the single point of contact for multiple Federal and State Based organizations including, but not limited, to state Departments of Insurance (DOIs) in coordination with corporate affairs and regulatory compliance (when appropriate), exchange regulatory boards, and exchange operation committees. **_Exchange Facilitator_** + Research, review, analyze, and disseminate timelines/deadlines/due dates, exchange requirements, and required documents (i.e., templates) to all associated internal teams in support of efforts to participate in Exchange operations and integration with the Federal and State Based health insurance exchange platforms. This dissemination effort includes - but is not limited to - maintenance of Humana's internal Exchange SharePoint site. + Collaborate with product strategy, product strategy advancement, information technology, vendor, and other implementation teams to gather requirements associated with product development, product expansion specific to Exchange operations (i.e., data transmission) and integration efforts for Federal and State Based health insurance exchange platforms. + Establish and facilitate regular meetings with all associated internal teams in support of Exchange operations and integration efforts for Federal and State Based health insurance exchange platforms. + Partner with Federal and State Regulatory agencies, vendors, and multiple internal teams to analyze requirements to identify and document meaningful executable tasks to establish a workable project plan, calendar, schedule of events, and product guidance for Exchange operations and integration efforts for Federal and State Based health insurance exchange platforms. + Operational ownership of all communication to contribute toward strategy execution for Exchange operations and integration efforts for Federal and State Based health insurance exchange platforms, including documenting processes for managing security access, utilizing each SBE's portal/website, etc. + Facilitate the gathering of required information and the completion of applications, documents, and points of contact for all Exchange operations and integration efforts for Federal and State Based health insurance exchange platforms in accordance with individual Federal and State regulatory organizations. + In coordination with corporate affairs, assist in collecting and disseminating information about future requirements released by Federal and State regulatory organizations concerning Exchange operations and the Federal and State Based health exchange platforms. **Use your skills to make an impact** **Required Qualifications** + 5 or more years of health industry experience. + 3 or more years of ACA/Health Insurance Exchange Qualified Health Plan (QHP) or Qualified Dental Plan (QDP) experience with Federal and/or State Based health insurance exchange platforms + Experience working with directly health insurance regulatory entities + Experience researching and analyzing Federal and State requirements + 2 or more years of project leadership experience + Proficient Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint as well as in Adobe Acrobat + Hours: 9am to 5 pm EST; will also work PST hours for SBE support (i.e., occasional meetings **Preferred Qualifications** + Experience with Specialty, Dental, and/or Vision products. + Experience/familiarity with the Individual QDP health insurance exchange + 3 or more years of experience with Federal and State legislation and policy review and communication to diverse teams across a wide range of disciplines + 3 or more years of external facing interactions with Federal and State regulatory agencies. + Demonstrated attention to detail and accuracy + Proven analytical and problem-solving ability + Complex program and project management skillset with the ability to synthesize inputs across multiple disciplines and ensure a quality output + Excellent oral and written communication skills. This includes ability to collaborate effectively with associates across all levels of the organization + Oversight experience working with multidisciplinary teams of high performing subject matter experts **Additional Information** **Work Style** : Remote US (excluding AK & HI) **Location:** This role is posted remote - nationwide. Regardless of location, it is expected that this person will work East Coast (EST) hours and, when needed, will also work West Coast (PST) hours for SBE support (i.e., occasional meetings). **Additional Information** As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + 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 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 Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-BB1 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. $86,300 - $118,700 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. Application Deadline: 01-09-2026 **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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

We are currently hiring for an RN Concierge Care Manager - Case Management to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager - Case Management, you will provide care management services to more than 2 million members in South Carolina and nationally, administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health, identify risks and provides outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life. Description The position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office. To work from home, you must have high-speed (non-satellite) internet and a private, secure home office. Attach a copy of your current RN license report to your application, or Include your RN license number on your resume Candidates who live within 50 miles of the Columbia office (4101 Percival Rd Ste 120, Columbia, SC 29229) and reside in South Carolina will be required to come on-site for one day of orientation to receive their equipment. After orientation, the position will be fully remote. This requirement does not apply to candidates residing in other states. Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST or 8:30am-5:00pm EST and will be fully remote. To work from home, you must have high-speed (non-satellite) internet and a private, secure home office. What You'll Do: Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations and/or those with complex conditions. Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services. Participates in team training and continuing medical education. Prepares for external audits and quality assurance efforts. To Qualify for This Position, You'll Need the Following: Required Education: Associate's degree in nursing OR Graduate of Accredited School of Nursing OR master's degree in social work, Psychology, or Counseling (Div. 75 and 6B) only. Required Work Experience: 5 years' case management experience as an RN OR 2 years' case manager experience as an RN in a health insurance environment. Required Skills and Abilities: Working knowledge of word processing software Knowledge of quality improvement processes and demonstrated ability with these activities Knowledge of contract language and application Ability to work independently, prioritize effectively, and make sound decisions Demonstrated customer service, organizational, and presentation skills Demonstrated proficiency in spelling, punctuation, and grammar skills Demonstrated oral and written communication skills Ability to persuade, negotiate, or influence others Analytical or creative thinking skills Ability to handle confidential or sensitive information with discretion Required Software and Tools: Microsoft Office Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, or counselor in state of hire (Div. 75 only). Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health) Preferred Work Experience: 5 years' experience in case management in a sub-specialty area (i.e. ICU, Palliative Care, Hospice, or Home Health, Behavioral health, and Case Management.) Preferred Skills and Abilities: Strong communication and customer services skills Excellent analytical skills to problem solve and remedy issues immediately Ability to work in an autonomous environment or leadership capacity Preferred Software and Tools: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue. Preferred Licenses and Certificates: Case manager certification, clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description Logistics: Palmetto GBA- one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle, Columbia, SC, 29203. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment. What You'll Do: May perform any or all of the following in the enrollment of providers: determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth review and verification/validation of provider data; verifies provider data by use of information databases and various organizations/agencies to ensure authenticity; sets up/tests EFT accounts. Processes/enters/updates provider data information/applications into appropriate enrollment database used in evaluating/tracking the processing of the application and/or updating of provider directories. Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone). Obtains information from internal department, providers, government and/or private agencies, etc. to resolve discrepancies/problems. Supplies enrollment applications and general information on the enrollment process to interested enrollees. Contributes to and participates on special projects related to provider files. Assists technical support staff with testing system changes related to provider files. Assists with process improvements related to Provider Enrollment. Assists with provider education and provider services training. To Qualify for This Position, You'll Need the Following: Required Education: Bachelor's degree equivalency: Four (4) years job-related work experience or associate's and two (2) years job related work experience. Required Skills and Abilities: Working knowledge of word processing, spreadsheet, and database software. Good judgment skills required. Effective customer service and organizational skills required. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Basic business math proficiency required. Analytical or critical thinking skills required. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. We Prefer That You Have the Following: Preferred Education: Bachelor's degree in business administration or health administration. Preferred Skills and Abilities: In-depth knowledge of provider certification process, claims processing operations/systems, and pricing methodology and discount programs. In-depth knowledge of Medicare program instructions/regulations related to provider enrollment/issues. Effective presentation skills. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Become a part of our caring community and help us put health first The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care (VBC) principles. This market/center-specific role requires flexibility to adapt responsibilities as needed and demands a unique blend of clinical management, financial/business acumen, and strategic partnership to optimize patient care and business outcomes. KEY RESPONSIBILITIES Leadership & Organizational Management: * Understand organizational & market priorities, trends, and goals, to develop a clinical strategy to advance clinical talent and performance * Interview, hire, and supervise clinical teams to staff and develop a high-quality clinical team with strong engagement, patient-first culture, and talent retention * Closely engage and communicate with clinicians and care teams, conducting weekly onsite center visits, holding regular individual 1:1s and clinician pod meetings, and actively participating in monthly leadership meetings * Deeply understand, support, and improve primary care clinician performance through understanding of individual & care team context, effective use of data, and effective coaching of clinicians and care teams * Engage in regular market performance (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical initiatives * Champion our senior-focused primary care strategic vision and initiatives and foster stakeholder relationships, including health plan partners, healthcare providers (e.g. specialists, hospitals) and social services, to improve our community of care locally * Represent CenterWell/Conviva brands in local communities and related media activities while collaborating with the recruitment team to build and network a pipeline of high-quality primary care clinicians (physicians, APPs, MAs, and other clinical professionals) * Utilize clinical performance dashboards and data tools to support stack ranking, performance analysis, and targeted strategy development * Foster a culture of continuous learning and professional growth among clinical teams Clinical/Patient Management: * Foster a robust patient-centered and value-based clinical vision, strategy, and culture locally that orients care teams around excellence in patient care, teamwork, outcomes * Deliver leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization * Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments are accurate and that performance improvement and coaching initiatives are precise * Identify critical issues for high-risk patients during case reviews & other forums, and model and drive clinical excellence * Conduct root cause analysis of care opportunities from both individual, team, and systems perspectives and partner with clinical and operational colleagues to improve high-reliability care as a team * Ensure clinicians effectively co-manage high-risk episodes of care and patients with partnered Care Integration Team (CIT) resources and programs for transitions of care management (TCM), high-risk patient management (HRPM), and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization * Monitor and manage daily patient care and initiatives to improve team-based key performance indicators (KPIs), such as patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals * Personally deliver high-quality primary care and demonstrate a high degree of patient care ownership and clinical excellence in age-friendly senior primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management * Spend 20-50% of time on direct patient care, with remaining time dedicated to administrative responsibilities. The percentage of time may vary by market needs and by staffing levels throughout the year * Support clinical quality performance improvement in areas such as MRA, Stars, and prevention of unnecessary utilization through provider education and coaching * Promote team-based care delivery and foster collaboration across interdisciplinary teams Dyad Partnership: * Collaborate with operational leaders (Associate Operations Director and/or Market President) and Shared Services partners to align on clinical and operational goals, strategic planning, and budgeting * Maintain regular communication to align on performance, strategies, and team communication and management, ensuring unified decision-making and consistent messaging for cohesive leadership * Work together towards common goals that support the mission, vision, values, and overall patient experience outcomes, managing clinic/market dynamics and engagement * Partner on strategic and operational insights, including capital and operational budgeting, and monitor clinical & financial performance and metrics * Review clinician schedules and incentive plans to align with patient care access and management goals Use your skills to make an impact Required Qualifications: * Graduate of an accredited medical school (MD/DO) with a current medical license, maintaining licensure requirements of the state of jurisdiction * Board Certification in Family Medicine, Internal Medicine or Geriatric Medicine * Minimum five years of experience in outpatient practice, with clinical experience in primary care, senior health, and value-based care (VBC) * Minimum three years of experience successfully leading clinicians in a leadership role with demonstrated impact on clinician talent, culture, and performance, and effective partnership with operations and supporting teams * Skilled in use of clinical technology platforms and resources, such as EMR systems (e.g. athenahealth, Epic, eClinicalWorks), voice documentation tools (e.g. Dragon, Abridge), and clinical evidence & pathway resources (e.g. UpToDate) * This role is considered patient-facing and is part of CenterWell's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB * Candidates selected for this job will be required to adhere to Humana's flu vaccine policy Additional Information Social Security Task Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. #LI-CB2 #physiciancareers 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. $246,100 - $344,200 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 About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. 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.

**Become a part of our caring community and help us put health first** Humana is a publicly traded, Fortune 100 health benefits company with a long history of successful innovation and reinvention. It has transformed itself from the largest US nursing home company in the 60's, to the largest US hospital corporation in the 80's, to a leading health benefits company beginning in the 90's. Today, Humana is a leader in consumer-focused health solutions and is one of the largest health benefits organizations in the country. Consumer Segment Team Identifying and delivering new avenues of growth is a critical company priority. The Consumer Segment team is an entrepreneurial, multi-functional team within Humana's Medicare and Medicaid business unit. The team is focused on driving industry leading membership growth, retention and health outcomes by identifying new consumer insights, developing growth strategies, and activating them across the enterprise to serve the unique needs of prioritized segments. Humana is seeking an experienced team member with meaningful strategy consulting or healthcare strategy experience to join this team. As Strategy Advancement Advisor, you will support development and implementation of consumer segment strategies that drive growth and retention while optimizing member experience and outcomes. You'll collaborate with teammates and cross-functional partners to frame up business questions, conduct analyses, and recommend solutions. You will own segment specific strategies including Hispanic and Age-Ins, and also help answer key strategic business questions that arise during the annual product/sales cycle across multiple domains, including product design, plan footprint, marketing and sales performance, membership analytics, customer/provider satisfaction and more. You will proactively identify new consumer insights and create business cases to support new pilots and initiatives to address critical unmet consumer needs. **Key Responsibilities Include** : + Managing analysis and/or work streams within high-profile, high-impact strategy projects + Conducting industry, market, competitor, and financial analysis and deliverables that clearly frame objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations + Conducting interviews, working sessions, and report-outs with associates and leaders across the company + Own development and presentation of key deliverables for leadership and cross-functional partners + Innovate new pilots and member experiences to drive growth and improved retention + Support business case development for key initiatives **Use your skills to make an impact** **Required Qualifications** + 7+ years of full-time relevant strategic work experience, ideally post-MBA + Strategy management consulting experience + Experience leading broad initiatives with cross-functional collaboration + Strong problem-solving skills and the ability to perform complex qualitative and quantitative analysis + Experience leveraging consumer insights to design and implement new products/services/solutions + Proficiency in verbal/written communication to senior and executive leadership + Proficient in delivering engaging and informative presentations to diverse audiences **Preferred Qualifications** + MBA, MPH, PhD, or graduate degree in a management field + Prior healthcare industry experience, preferably in the managed care or provider sector 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. $115,200 - $158,400 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. Application Deadline: 12-11-2025 **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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

**Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Associate Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **In addition, the Associate Actuary will:** + Support long term projects aimed at advancing technical maturity, process efficiency, and forecasting accuracy. We are looking for creativity, curiosity, and a desire to explore and influence uncharted territory. + Conduct independent research, collaborate across many teams/departments, and require strong communication skills to be successful in the job. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + Meets eligibility requirements for Humana's Actuarial Professional Development Program (APDP) + MAAA + Strong communication skills + Demonstrated ability to communicate technical information with audiences not in the actuarial space + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + 3+ years health industry experience with ASA, or 1+ years health industry experience with FSA + 2+ years SQL experience, or equivalent skillset **Preferred Qualifications** + Medicare Advantage background + Creative, high degree of self-accountability + Experience in Python, PowerApps, and PowerBI 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. $106,900 - $147,000 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. Application Deadline: 12-30-2025 **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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Become a part of our caring community and help us put health first The Medical Assistant is the first point of contact for patient care. Responsible for administrative duties in addition to patient care. The Medical Assistant performs varied activities and moderately complex administrative, operational, and customer support assignments. Typically works on semi-routine assignments. This is a FLOAT position and will require you to work between offices as business needs require in the Columbia area. Mileage will be reimbursed for travel between clinics. The Medical Assistant performs clinical duties such as discussing symptoms, obtaining vital signs, medication/vaccine administration, phlebotomy, collecting specimens, performing diagnostic screening tests, sterilizing/cleaning equipment, maintaining examination rooms, and documenting information into the electronic medical records system. Collaborates closely with Physicians and Advanced Practice Providers. Delivers direct patient care dependent on what active certification allows. Decisions typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has latitude over prioritization/timing, and works under minimal direction. Follows standard policies and procedures that allow opportunity for interpretation/deviation and/or independent discretion. Use your skills to make an impact Required * Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5+ years of experience and approval from Provider * High school diploma or equivalent * CPR Certified * This role is considered patient facing and is part of the company's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB Preferred * Certified or Registered - (Arizona, Indiana, & South Carolina candidates require Medical Assistant Certification or Registration) * Phlebotomy experience• Medication/vaccine administration experience * 1+ years MA experience * Value Based Care experience including knowledge of HEDIS, CPT/ICD coding, and CAHPS/HOS Patient Experience. * Bilingual proficiency in English and Spanish - must pass proficiency exam prior to foreign language communication 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. $40,000 - $52,300 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 About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. 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.

**Become a part of our caring community and help us put health first** The Rx Clinical Programs Pharmacy Technician Representative 2 supports Pharmacists and patients by executing programs developed to improve overall health outcomes with a focus on prescription drugs, and medication therapy and helps drive the strategy on comprehensive medication reviews. The Rx Clinical Programs Pharmacy Technician Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Rx Clinical Programs Pharmacy Technician Representative 2 assists in driving prescription drug optimization in cases where patients are taking multiple medications. Through effective communication, helps drive health awareness with patients through Rx Education and targeted quarterly campaigns. Assists Pharmacists by placing and retrieving calls to confirm patients are taking drugs and provides counseling. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. In this role, you will: + Make outbound and take inbound calls + Communicate with Humana members + Collect medication history information + Prepare members for a comprehensive medication review **Use your skills to make an impact** ****PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT) **** **_*Earn a $1,500 hiring sign on bonus!_** * (50% payable at hire and 50% payable at 180 days; you must be employed until that date to be eligible to receive the payment!) + Applicable to external candidates only **Required Qualifications** + **Resident State Pharmacy Technician License** **OR** **National Pharmacy Technician Certification** + High School Diploma or equivalent + Excellent communication skills both written and verbal + Applied knowledge of insurance processing, customer service or call center processes and practices + High speed hardwired internet and phone, minimum speed 20Mbps + Must have a designated work area with a door that locks **Schedule:** Must have the flexibility to work any hours between 8:00am-7:00pm EST and holidays/weekends and overtime as needed. + **You must be on time, dressed appropriately, with your camera ON during 2+ weeks of training and for other meetings required by leadership** . Attendance is vital for success, time off during your 180-day appraisal period is not permitted. Exception: Should a Humana-observed holiday occur during training or within the 180-day appraisal period, you will have the holiday off (paid). **Preferred Qualifications** + Associate's degree or equivalent work experience + Experience in mail order and/or retail pharmacy setting + Ability to speak both English and Spanish fluently + Previous call center experience in a pharmacy setting + Strong communication and telephonic skills + Ability to solve problems and encourage others in collaborative problem solving + Self-directed, but also able to work well in a group + A positive, proactive attitude, energetic, highly motivated and a self-starter + Work ethic that is focused, accurate and highly productive **Referral Bonus Information** Associates may receive a bonus for the referral of external candidates to this requisition, provided that all other eligibility requirements are met. 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. $40,000 - $52,300 per year **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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Intern position utilized for training an active high school or college student towards an entry level role. Responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry-level tasks and for learning professional-level tasks relating to area operations. Description Logistics: Palmetto GBA, - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This is a part-time position (20-27 hours per week) Monday - Friday. This posit This role is located at 17 Technology Circle, Columbia, SC 29203. What You'll Do: Completes tasks for maintaining information used in the department. Maintains documents, spreadsheets, databases or related items. Utilizes various systems and tools, performs research and assists with projects as needed. Follows established procedures. Participates in business unit/department training designed to help this position acquire applicable knowledge/skills in their area of study. Completes area tasks that are conducive to learning the departmental procedures and applying industry/field best practices. May communicate with other areas of the company. May create, present and/or report on area statistics and/or knowledge acquired. Perform tasks that help in learning the business area and which provide an overall view of company operations. Assist other staff members with everyday tasks to gain an understanding of business operations and workflow. Completes other assigned area related tasks. To Qualify For This Position, You'll Need The Following: Required Education: High School Diploma or equivalent Required Specialized Training: Must have a minimum of 12 semester hours earned in the field(s) specified by the hiring area and must be currently enrolled in college and working towards obtaining at least a 4-year degree in the field(s) specified by the hiring area. (PLEASE UPLOAD A COPY OF YOUR UNOFFICIAL TRANSCRIPTS(S) WITH RESUME.) Required Work Experience: No previous work experience is required. Required Skills and Abilities: Effective oral and written communication skills. Strong organizational abilities and a keen attention to detail. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Good planning and multi-tasking skills. Proficient listening skills, coupled with the capability to adhere to instructions and pose inquiries, are essential for ensuring a productive internship. Required Software and Tools: Microsoft Office. We Prefer That You Have The Following: Microsoft Office. 1 year-general work history/experience. Accounting Majors (Approximately 12 credit semester hours in accounting) Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: (Standard, unless otherwise directed) We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: (Standard, unless otherwise instructed during intake) After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Assists in the implementation of activities and projects for assigned IT business area(s). will end in May 2026 and does require some on-site work in Columbia, SC. Description What You'll Do: Assist with the implementation of various activities and projects for assigned business units. Identify areas of needed improvement and communicate with team and management. To Qualify for this Position, You'll Need: Bachelor's degree OR Associate's degree plus two years of related work experience. Excellent written and verbal communication and interpersonal skills. Ability to work well under close supervision and as part of a team. Attention to detail. Ability to complete assigned work in a timely manner. Microsoft Office skills. We Prefer that You Have: Bachelor's degree in computer science or other job-related field OR Associate's degree in computer science or other job-related field plus two years of job-related experience. IT internship or job-related work experience. What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Our comprehensive benefits package includes: 401(k) retirement savings plan with company match Subsidized health plans and free vision coverage Life insurance Paid annual leave - the longer you work here, the more you earn Nine paid holidays On-site cafeterias and fitness centers in major locations Wellness programs and a healthy lifestyle premium discount Tuition assistance Employee Assistance programs Discounts to movies, theaters, zoos, theme parks and more What to Expect Next: After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications. This may include an interview and/or email communications. Prioritization is given to those candidates who demonstrate the preferred qualifications. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Become a part of our caring community and help us put health first The Medical Social Worker participates in the interdisciplinary care provided to home health patients. The Medical Social Worker functions to evaluate and develop a plan of care personalized to fit the patient's emotional and social needs. The Medical Social Worker provides direction and supervision of the Social Worker Assistant as required and when involved in the patient's plan of care. The Medical Social Worker works within CenterWell Home Health's company-specific policy and procedures, applicable healthcare standards, governmental laws, and regulations. * Assesses the patient's social and emotional state as it relates to his or her illness or injury, needs for care and his or her response to such treatment, and adjustments to care. * Assesses any relationships of the patient's medical and nursing needs in the home setting, financial resources, and available community resources. * Provides any appropriate action to obtain available community resources to assist in resolving issues that may be impeding the patient's recovery. * Instructs patients and families in treating and coping with social and emotional response connected with Provides ongoing assessment of patient and family needs and responses to teaching * Assists the physician and other health team members in understanding the significant social and emotional factors related to the patient's health Participates in the development and periodic re-evaluation of the physician's Plan of Care for the patient. * Observes, records, and reports changes in patients' condition and response to treatment to the Clinical Manager and the Participates in the discharge planning process * Participates as a member of the interdisciplinary care team in care coordination activities and acts as a resource to other health team members in the identification and resolution of patient needs * Supervises instructs and evaluates the performance of the Social Work Assistant (BSW) to assure that all medical social services are provided to patients in compliance with Company, government, and professional standards * Maintains and submits documentation as required by the company and/ or facility including any case conferences, patient/physician community contacts, visit reports progress notes, and confers with other health care disciplines in providing optimum patient. Use your skills to make an impact Required Skills/Experience * Masters or doctoral degree from a school of social work accredited by the Council on Social Work Education. * Social Worker licensure in the state of practice; if required by state law or regulation. * A valid driver's license, auto insurance, and reliable transportation are required. * Proof of current CPR certification * Minimum of one year of experience as a social worker in a health care setting, home health, and/or hospice. * Knowledge of and the ability to assist with discharge planning needs, and to obtain community resources (housing, shelter, funeral/memorial service arrangements, legal, information and referral, state/federal financial and medication programs, and eligibility. * Excellent oral and written communication and interpersonal skills. * Must read, write and speak fluent English. * Knowledge of medications and their correct administration. * Ability to organize tasks, develop action plans, set priorities, and function under stressful situations. * Ability to be flexible in work hours and travel locally. * Ability to communicate effectively with patients and their family members and at all levels of the organization. * Maintains current licensure certifications and meets mandatory continuing education requirements. * Must read, write and speak fluent English. * Must have good and regular attendance. * Performs other related duties as assigned. * Valid driver's license, auto insurance and reliable transportation. 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. $59,300 - $80,900 per year 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 About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. 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.

**Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. We are seeking a Lead Product Manager to drive the vision, strategy, and execution of our Sales and Marketing Technology initiatives. This role will be pivotal in aligning product capabilities with business objectives, ensuring seamless integration across platforms, and delivering innovative solutions that empower our sales and marketing teams to achieve growth targets. The Lead Product Manager Conceives of, develops, delivers, and manages products for customer use. The Lead Product Manager works on problems of diverse scope and complexity ranging from moderate to substantial. **Key Responsibilities:** + Define and own the product roadmap for Sales Technology solutions and their intersection with Humana's Marketing organization. + Collaborate with cross-functional teams including Sales, Marketing, Engineering, and Data Analytics to deliver impactful products. + Lead discovery sessions to identify pain points and opportunities for process optimization. + Manage vendor relationships and evaluate third-party tools for integration. + Establish KPIs and measure product performance to ensure continuous improvement. + Advocate for best practices in CRM, marketing automation, and sales enablement technologies. **Use your skills to make an impact** **Qualifications:** + Bachelor's degree in Business, Marketing, Computer Science, or related field; MBA preferred. + 7+ years of product management or product ownership experience, with at least 3 years in Sales/Marketing Technology. + Experience with sales platforms (ie.Salesforce, Highspot and Sproutloud). + Proven track record of delivering enterprise-level solutions in CRM, marketing automation, and analytics platforms. + Strong leadership and stakeholder management skills. + Excellent communication and analytical abilities. **Preferred Skills:** + Familiarity with data-driven marketing and personalization strategies. + Agile methodology experience. **Why Join Us?** + Opportunity to lead strategic initiatives impacting revenue growth. + Collaborative and innovative work environment. + Competitive compensation and benefits package. 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. $126,300 - $173,700 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. Application Deadline: 12-30-2025 **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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plans, and prepares/submits reports on the results of audits. Description The Auditor is responsible for assist in executive of financial, compliance, and operations audits. This is a remote full time position working 8:00 to 5:00 Monday through Friday. Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance. Audits include interviewing key personnel, conducting testing, evaluating internal controls, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings. Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Conducts testing of corrective actions as identified. Conducts special audit studies for management, such as those required to discover controls for prevention of fraud. Prepares reports of finding and recommendations for management. Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel. Required Education: Bachelor's in a job related field Required Work Experience: No previous work experience required. Required Skills and Abilities: Knowledge of the principles and practices of auditing. Ability to analyze and determine the applicability of financial data. Ability to draw conclusions and make appropriate recommendations for analyzed data. Ability to gather information by examining records and documents and interviewing individuals. Strong interpersonal skills and the ability to work professionally with persons at all levels. Ability to communicate clearly and effectively in oral and written form. Ability to handle sensitive matters on a confidential basis. Required Software and Tools: Microsoft Office. Preferred Licenses and Certificates: Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) or Certified Information Systems Auditor (CISA) Work Environment: Typical office environment. Travel between office buildings required. Out of town travel may be required. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits at the first of the month following 28 days of employment: Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Salary Range: Range Minimum$19.36 Range Midpoint$27.51 Range Maximum$35.67Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

**Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Coordinates the clinical resolution with internal/external clinician support as required. Documents and summarizes to all parties involved in the case the investigation's results. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be needed including timeframes when physician is available for peer to peer review, and forward to physician review companies or TQMC. Monitor and follow up for timeliness and review response and determination to insure follows TRICARE policy requirements. If discrepancies found will send back for follow up review and correction as needed. + Review, coordinate, arrange and maintain Second level Review /Reconsideration records and patient and provider response letters + Provide education to beneficiaries and providers regarding second level review time frames, process and review determinations. If needed provide education on alternatives for services that may be not be approved + Maintain knowledge of TRICARE, all HGB policies and procedures as well as medical necessity review criteria and privacy requirements **Use your skills to make an impact** **Required Qualifications** + Our Department of Defense contract requires U.S. Citizenship + Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) + HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. + Active unrestricted RN license + 3 years of clinical RN Experience + Appeals nursing experience + Claims experience + Proficient with Microsoft Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review/Quality Management experience + Experience working with MCG guidelines + Working knowledge of ICD-9 or ICD-10, HCPCS, DRG use + Experience with TRICARE contracts and/or the military health care delivery system + Knowledge of TRICARE policies and programs + Bachelor's degree **Additional Information** **Work Style** : Remote **Work Days/Hours:** Monday - Friday; 8:00 a.m.-5 p.m. Eastern Standard Time **Work at Home Requirements** To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria: + 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 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 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. $71,100 - $97,800 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. **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 complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************