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Humana jobs in Lexington, KY - 279 jobs

  • Senior Learning Design Professional

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **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. IFG is a subsidiary of Humana The Senior Learning Design Professional uses instructional design, cognitive psychology and adult learning theory to determine the appropriate solution to a knowledge or performance gap. The Senior Learning Design Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **Position Overview** The Senior Learning Design Professional leads the design and development of engaging, effective learning experiences that drive performance improvement for Medicare Advantage sales agents and agency partners. This role requires deep expertise in instructional design, eLearning development, and adult learning principles, combined with the ability to translate complex Medicare regulations and sales strategies into accessible, actionable training content. **Key Responsibilities** **Learning Solution Design & Development** + Analyze learning needsthrough stakeholder consultation, performance data analysis,and needsassessments to determineappropriate learninginterventions. + Design and develop multi-modal learning solutions including eLearning modules, instructor-led training materials(slide decks, facilitator guides), performance support tools(meeting-in-a-box, job aids), microlearning assets, and mobile learning experiences that reflect diverse representation and are accessible to all learners. + Write clear, measurable learningobjectives,and design performance assessments thatvalidatelearning transfer and business impact. + Create storyboards, scripts, and interactive eLearning courses using industry-standard authoring tools (Articulate Storyline, Rise,Vyond, Cornerstone). + Develop visual assets and multimedia content that enhance learner engagement and knowledge retention while meeting WCAG 2.1 AA accessibility standards. + Ensure all learning content meets compliance requirements for Medicare Advantage andmaintains CMS regulatory alignment. + Design content that accommodates multiple carriers' products, policies, and processes (Humana plus 10+ other insurance carriers). + Write authentic and valid knowledge assessments. **Learning Facilitation** + Facilitate engaging virtual instructor-led sales skills and leadership training as well as ad hoc team building exercises. **Stakeholder Partnership & Consultation** + Partner with subject matter experts, compliance leaders, sales managers, and agency principals to gather content requirements andvalidateaccuracy. + Conduct consultative needs analysis todeterminewhether learning solutions are necessary or if alternative performance interventions are moreappropriate. + Present design concepts and prototypes to stakeholders, incorporating feedback whilemaintaininginstructional integrity. + Educate stakeholders on adult learning principles andevidence-based instructional strategies. **Quality Assurance & Continuous Improvement** + With our organizationeffectivenessprogressional, track and analyze training program effectiveness through learner satisfaction surveys, knowledge assessments,completion rates,and performance metrics. + Conduct regular content audits to ensure materialsremaincurrent with Medicare regulations, product updates, and industry changes. + Implement iterative improvements based on learner feedback, performance data, and evolving business needs. + Maintain content version control and documentation in SharePoint andourlearning management system(Cornerstone). **Learning Technology & Innovation** + Leverage Cornerstone LMS capabilities to deliver personalized learning paths and track learner progress. + Utilize collaboration tools (Microsoft Teams, SharePoint, Zoom, Lucid Chart, PowerPoint) tofacilitatecontent review processes and knowledge sharing. + Explore and recommend emerging learning technologies. + Contribute to learning design standards, templates, and best practices documentation. **Use your skills to make an impact** **Required Qualifications** **Education & Experience** + Bachelor's degree in Instructional Design, Education, Psychology, Communications, or related field + 5+ years of learning design and eLearning development experience + Demonstrated experience designing learning solutions for complex,highlyregulated subject matter + Portfolioshowcasingdiverse learning deliverables (eLearning, blended learning, performance support) **Technical Skills** + **Expert** **proficiency** **in eLearning authoring tools:** Articulate Storyline 360, Rise 360, Vyond + **Strong** **proficiency** **in:** Learning Management Systems (Cornerstone preferred),Microsoft Office Suite (PowerPoint, Word, Excel), Microsoft Teams, SharePoint + **Working knowledge of** **:** SCORM/xAPIstandards, basic HTML/CSS + **Audio/visual production skills:** Audio editing (Adobe Audition), video editing (AdobeAfterEffects,Adobe Premiere), graphic design (Adobe Creative Suite basics) + **General tech-savviness:** Comfortable learning new platforms quickly, troubleshooting technical issues, and adapting to evolving technology landscape **Knowledge & Competencies** + Deep understanding of adult learning principles, instructional design models (LLAMA,SAM, Backwards Design, Kirkpatricklevels of evaluation,Cathy Moore'sAction Mapping, Bloom's Taxonomy), and evidence-based learning strategies + Ability to translate complex, technical subject matter (like Medicare Advantage plan structures, CMS regulations, sales methodologies) into clear, engaging learning content + Well-versed in psychometrics + Engagingfacilitator in virtual environments + **Business acumen:** Data-driven decision-making mindset; ability to connect learning solutions to business outcomes and ROI + Strong project management skills with ability to manage multiple concurrent projects and meet deadlines + Exceptional written and verbal communication skills + Collaborative mindset with ability to navigate competing stakeholder priorities + Experience with accessibility standards (WCAG, Section 508) + Familiarity with learning analytics and data visualization tools (Power BI) **Preferred Qualifications** + Master's degree in Instructional Design, Learning and Performance, Education, or related field + Experience in healthcare, insurance, or other highly regulated industry + Knowledge of Medicare Advantage products, sales processes, or insurance compliance **Additional Information** **Virtual Pre-Screen** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review 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. **Work-At-Home Requirements** 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 Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. **Team Culture & Working Environment** **About IFG** **and Our Team** Innovative Financial Group (IFG) is a subsidiary of Humana that operates as a field marketing organization (FMO), selling Medicare Advantage and supplemental insurance products from 10+ carriers-not just Humana. Our learning design team supports IFG's call center agents and agency partners, creating training that helps them navigate multiple carriers' products, regulations, and sales processes. We're a newly formed team building IFG University from the ground up-we've selected Cornerstone as our LMS, we're designing our content strategy based on comprehensive stakeholder research, and we're establishing processes that will scale. This is a unique opportunity to shape the foundation of a learning function and make a lasting impact. **What We Value** + **Collaboration over silos:** We break down barriers between Marketing, Training, Communications, and Learning Design. + **Learner-centricity:** We design back from what agents need, notwhat'seasiest for us. + **Data-informed decisions:** We measure what matters and continuously improve. + **Intellectual curiosity:** We embrace complex subject matter and find ways to make it accessibleanddigestible. + **Inclusive leadership:** We create space for diverse perspectives and challenge assumptions respectfully. + **Agility:** We move quickly, learn from experiments, and adapt based on feedback. + **Friendly and Fun:** Weinteract with others in a positive way and know that learning should be enjoyable! **Work Model** + **Remote work with up to 10% travel** for team meetings, training delivery, or stakeholder sessions + Collaborative team culture with regular synchronization and knowledge sharing + Opportunities for professional development and skill building + Supportive leadership committed to your growth and success **Our Commitment to Inclusion & Accessibility** Every member of our team is responsible for creating learning experiences that reflect diverse representation and are inclusive and accessible to all learners. This includes: + Designing content that features diverse learner personas and scenarios. + Ensuring all digital learning materials meet WCAG 2.1 AA accessibility standards (screen reader compatibility, captions, color contrast, keyboard navigation). + Using inclusive language,interrogating biases,and avoiding assumptionsabout learners' backgrounds, abilities, or experiences. + Creating multiple pathways for learners todemonstrateknowledge and accommodate differentabilitiesandlearning preferences. + Continuously seeking feedback from diverse learner populations to improve inclusivity. 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. Application Deadline: 01-15-2026 **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 ***************************************************************************
    $71.1k-97.8k yearly Easy Apply 3d ago
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  • Actuary, Pricing

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **Become a part of our caring community and help us put health first** The Actuary, Pricing is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new plans and benefit changes. Provides guidance to Product Development on new product/benefit cost impacts. Develops and maintains pricing tools that price standard and custom benefits. The Actuary, Pricing works on problems of diverse scope and complexity ranging from moderate to substantial. The Actuary, Pricing establishes market level financial metrics to align with segment profitability goals, analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics. Leverages market level projections and experience data tools to research root cause and capture insights. Researches and understands competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth. Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations. + MAAA + Strong communication skills + Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending) + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage experience + Strong Communication Skills + Ability to manage large projects involving actuarial and non-actuarial staff 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. $129,300 - $177,800 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. Application Deadline: 01-21-2026 **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 ***************************************************************************
    $129.3k-177.8k yearly 37d ago
  • Processor, Coordination of Benefits

    Molina Healthcare Inc. 4.4company rating

    Lexington, KY job

    Provides support for coordination of benefits review activities that directly impact medical expenses and premium reimbursement. Responsible for primarily coordinating benefits with other carriers responsible for payment. Facilitates administrative support, data entry, and accurate maintenance of other insurance records. Job Duties * Provides telephone, administrative and data entry support for the coordination of benefits (COB) team. * Phones or utilizes other insurance company portals to validate state, vendor, and internal COB leads. * Updates the other insurance table on the claims transactional system and COB tracking database. * Review of claims identified for overpayment recovery. Job Qualifications REQUIRED QUALIFICATIONS: * At least 1 year of administrative support experience, or equivalent combination of relevant education and experience. * Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. * Strong verbal and written communication skills. * Ability to work cross-collaboratively across a highly matrixed organization and establish and maintain effective relationships with internal and external stakeholders. * Microsoft Office suite proficiency. PREFERRED QUALIFICATIONS: * Health care experience To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.65 - $31.71 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $21.7-31.7 hourly 2d ago
  • Supervisor, Pharmacy Operations/Call Center

    Molina Healthcare 4.4company rating

    Lexington, KY job

    Leads and supervises a team of pharmacy call center representatives and operations staff responsible to ensure that members have access to medically necessary prescription drugs. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. **Essential Job Duties** - Hires, trains, develops, and supervises a team of pharmacy service representatives supporting processes involved with Medicare Stars and Pharmacy quality operations. - Ensures that average phone call handle time, average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. - Ensures that adequate staffing coverage is present at all times of operation. - Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. - Responsible for key performance indicators (KPI) reporting to department leadership on a monthly basis. - Participates, researches, and validates materials for both internal and external program audits. - Acts as liaison to internal and external customers to ensure prompt resolution of identified issues. - Assists pharmacy leadership in the collection and tabulation of data for reporting purposes and maintains files of confidential information submitted for review. - Assures that activities and processes are compliant with CMS, National Committee of Quality Assurance (NCQA) guidelines, and Molina policies and procedures. - Participates in the daily workload of the department, performing Representative duties as needed. - Facilitates interviews with pharmacy service representative job applicants, and provides hiring recommendations to leadership. - Provides coaching for pharmacy representatives, and helps identify and provide for training needs in collaboration with pharmacy leadership. - Communicates effectively with practitioners and pharmacists. - Collaborates with and keeps pharmacy leadership apprised of operational issues, including staffing resources, program and system needs. - Assists with development of and maintenance of pharmacy policies and procedures - Participates in the development of programs designed to enhance preferential or required targeted drugs or supplies. **Required Qualifications** - At least 5 years of experience in health care, preferably within a health-related call center environment, or equivalent combination of relevant education and experience. - Knowledge of prescription drug products, dosage forms and usage. - Experience designing, implementing, monitoring, and evaluating metrics that measure call center agent productivity. - Working knowledge of medical/pharmacy terminology - Excellent verbal and written communication skills. - Microsoft Office suite, and applicable software program(s) proficiency. **Preferred Qualifications** - Supervisory/leadership experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Call center experience. - Managed care experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $55,706.51 - $80,464.96 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $28k-34k yearly est. 19d ago
  • Medical Director - Nat'l UM IP (4x10 hr)

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs with a context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical **Use your skills to make an impact** **Responsibilities** The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of mentored training, daily work is performed with minimal direction. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. **Required Qualifications** + MD or DO degree + **4 x 10h (Fri, Sat, Sun, Mon)** + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board Certification an approved ABMS Medical Specialty + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required. + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements. + Excellent verbal and written communication skills . + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines such as MCG or InterQual + Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialists + Advanced degree such as an MBA, MHA, MPH + Exposure to Public Health, Population Health, analytics, and use of business metrics. + Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. + The curiosity to learn, the flexibility to adapt and the courage to innovate **Additional Information** Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees. \#physiciancareers 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. $223,800 - $313,100 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: 04-30-2026 **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 ***************************************************************************
    $223.8k-313.1k yearly 60d+ ago
  • Adjudicator, Provider Claims-On the phone

    Molina Healthcare 4.4company rating

    Lexington, KY job

    Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. - Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. - Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. - Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. - Assists in reviews of state and federal complaints related to claims. - Collaborates with other internal departments to determine appropriate resolution of claims issues. - Researches claims tracers, adjustments, and resubmissions of claims. - Adjudicates or readjudicates high volumes of claims in a timely manner. - Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. - Meets claims department quality and production standards. - Supports claims department initiatives to improve overall claims function efficiency. - Completes basic claims projects as assigned. **Required Qualifications** - At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. - Research and data analysis skills. - Organizational skills and attention to detail. -Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Customer service experience. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $21.7-38.4 hourly 19d ago
  • Physician Primary Care

    Humana Inc. 4.8company rating

    Humana Inc. job in Lexington, KY

    Become a part of our caring community and help us put health first Join a Team That's Redefining Senior Primary Care: Humana's Primary Care Organization is one of the largest and fastest-growing senior-focused, value-based care providers in the country. With over 340 centers across 15 states operating under the CenterWell and Conviva brands, we're transforming healthcare by putting seniors at the heart of everything we do. As a Primary Care Physician at CenterWell Senior Primary Care, you'll be part of a collaborative, multidisciplinary team that includes nurse practitioners, pharmacists, care coaches, behavioral health specialists, and more-all working together to deliver personalized, high-quality care. We're not just improving healthcare-we're improving lives. That includes yours. Why You'll Love Working Here * Team-Based Care Model: Work alongside a dedicated care team that supports patients' physical, emotional, and social wellness. * More Time with Patients: See fewer patients per day and spend more time delivering meaningful care. * Supportive Culture: We foster a welcoming, inclusive environment where teamwork and growth are prioritized. * Work-Life Balance: Enjoy generous PTO, minimal call responsibilities, and CME time. Your Role & Responsibilities * Provide comprehensive care to seniors in accordance with clinical standards. * Collaborate daily with your care team to ensure coordinated, high-quality care. * Manage referrals, hospital/SNF coordination, DME, and home health services. * Participate in daily huddles. CAs tend to lead the huddles * Document care accurately and efficiently with support from quality-based coders. * Participate in on-call rotation and support growth initiatives at your center. * Ensure compliance with all licensing and accreditation requirements. * Spend 100% of your time clinically focused on direct patient care, inclusive of patient facing time and general administrative time (charting, meetings, etc.) as it relates to direct patient care. Use your skills to make an impact Compensation (base pay + quality metric bonus) can exceed $300K * DOE and Lucrative Sign-on Bonus Up to $60K We're hiring for CenterWell Regency Centre Clinic: 171 W Lowry Ln Suite 180 Lexington, KY 40503 What We're Looking For Required: * Graduate of accredited MD or DO program from an accredited university * Board Certification or Eligible to become certified (ABMS or AOA) in Family Medicine, Internal Medicine or Geriatric Medicine * Current and unrestricted medical license or willing to obtain a medical license in state of practice; eligible and willing to obtain licenses in other states in the region of assignment, as required * Excellent verbal and written communication skills * Demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients * Fully engaged in the concept of "Integrated team-based care" model * Willingness and ability to learn/adapt to practice in a value-based care setting * Superior patient/customer service * Basic computer skills, including email and EMR * This role is considered patient facing and is a part of our Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB Preferred: * Active and unrestricted DEA license * Medicare Provider Number * Medicaid Provider Number * Minimum of two to five years directly applicable experience preferred * Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value-based relationship environment * Knowledge of Medicare guidelines and coverage * Knowledge of HEDIS quality indicators Compensation & Benefits * Competitive base salary + annual bonus * Health insurance effective Day 1 * 401(k) with employer match * CME allowance + dedicated CME time * Occurrence-based malpractice coverage * Life & disability insurance * Generous PTO & paid holidays * Minimal call responsibilities Scheduled Weekly Hours 40 * Monday to Friday * 8:00 a.m. to 5:00 p.m. #physiciancareers #healtcarejobs #primarycare #LI-JB1 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. $219,400 - $306,900 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.
    $219.4k-306.9k yearly 1d ago
  • Business Intelligence Lead

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **Become a part of our caring community and help us put health first** We're seeking a Business Intelligence Lead to join our team. This role is ideal for a strategic thinker and hands-on thought leader who thrives at the intersection of data, business strategy, and cross-functional collaboration. You'll be responsible for transforming raw data into actionable insights that directly influence executive decision-making and drive enterprise-wide initiatives. **What You'll Do:** + **Lead Strategic BI Initiatives:** Design, develop, and deliver business intelligence tools and analyses that support key organizational priorities across sales, operations, and customer experience. + **Partner with Senior Leadership:** Serve as a trusted advisor to executives and business leaders, translating complex data into clear, actionable insights that inform strategic decisions. + **Drive Analytical Excellence:** Perform deep-dive analyses to uncover trends, relationships, and opportunities to inform decision-making. + **Ensure Data Quality and Governance:** Collaborate with data engineering and governance teams to ensure BI solutions are scalable, reliable, and aligned with enterprise standards. **What We're Looking For** + Proven experience in business intelligence, analytics, and/or strategy advancement, ideally in a lead or senior role. + Expertise in BI tools (e.g., Power BI, Tableau, etc), SQL, and modern data platforms (e.g., Snowflake, DataBricks, etc). + Strong business acumen and the ability to communicate complex data concepts to executive leadership and non-technical stakeholders. + Demonstrated success in leading cross-functional projects and influencing strategic outcomes. + A passion for uncovering insights and driving measurable impact through data. **Why Join Us** + Work directly with senior executives on high-visibility initiatives. + Be part of a team that values depth of thought, precision, and innovation. + Help shape the future of data-driven decision-making in a dynamic and evolving organization. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree and 8 or more years of technical experience in business intelligence, analytics, and/or strategy advancement, ideally in a lead or senior role. + Expertise in BI tools (e.g., Power BI, Tableau, etc), SQL, and modern data platforms (e.g., Snowflake, DataBricks, etc). + 2 or more years of project leadership experience + Advanced experience working with big and complex data sets within large organizations + Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction + Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs **Preferred Qualifications** + Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field + Advanced in SQL, SAS and other data systems + Expertise in data mining, forecasting, simulation, and/or predictive modeling + Experience creating analytics solutions for various healthcare sectors 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. $117,600 - $161,700 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: 01-16-2026 **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 ***************************************************************************
    $117.6k-161.7k yearly 5d ago
  • Associate Director - Data Platform Operations and Administration

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **Become a part of our caring community and help us put health first** The Associate Director, Database Administration manages and maintains all production and non-production databases. Responsible for standards and design of physical data storage, maintenance, access and security administration. The Associate Director, Database Administration requires a solid understanding of how organization capabilities interrelate across department(s). The Associate Director will lead the design, reliability, scalability, and operational excellence of Humana's enterprise data platforms across multi cloud and on-prem environments. This role is responsible for ensuring high availability, performance, security, compliance, and cost efficiency for mission-critical data systems supporting analytics, AI/ML, and customer-facing applications. This leader will partner closely with Application, Data Engineering, Analytics, Product, Security, Finance, and Platform Engineering teams to define and operate standardized, resilient, and automated database platforms across technologies such as SQL Server, Oracle, PostgreSQL, MongoDB, Snowflake, Databricks, and other modern data services. In addition, this role will spearhead the application of AI and Generative AI to database operations and data platform reliability-driving predictive insights, automated remediation, intelligent observability, and operational copilots that reduce manual overhead while maintaining strict healthcare compliance (HIPAA, PHI). **Key Responsibilities:** **Data Platform Strategy & Operations Leadership** + Define and execute the enterprise database and data platform operations strategy across cloud and on-prem environments. + Provide senior-level guidance on platform standards, architectural decisions, lifecycle management, and modernization of relational and non-relational databases. + Establish short-, mid-, and long-term roadmaps for data platform reliability, scalability, automation, and cost optimization. + Lead the operational maturity model for data platforms, aligned with SRE and platform engineering best practices. **Reliability, Availability & SRE for Data Platforms** + Own 24/7 availability and performance of mission-critical database and analytics platforms. + Lead escalated incident, problem, and root cause analysis for data platform outages, performance degradation, and data integrity issues (24/7/365). + Define and improve MTTD / MTTR through proactive monitoring, automation, and AI-assisted diagnostics. + Establish SLOs, SLIs, and error budgets for database and analytics platforms. **Database Operations & Managed Services** + Lead and govern Managed Service Providers (MSPs) supporting database operations across cloud and on-prem environments. + Build and maintain L2/L3 SOPs for database operations, backup/recovery, patching, failover, and disaster recovery. + Oversee change planning, release coordination, and operational readiness for database platform upgrades and migrations. + Support and guide cloud and on-prem database migrations, including legacy modernization initiatives. **Observability, Monitoring & Automation** + Establish enterprise-grade observability for data platforms, including metrics, logs, traces, query performance, and capacity forecasting. + Partner with observability teams to implement event correlation, anomaly detection, and intelligent alerting for databases and data pipelines. + Identify manual operational tasks and drive automation through scripting, APIs, and platform tooling. + Partner with DevOps and Platform Engineering on CI/CD for database changes, schema management, and infrastructure-as-code. **AI & GenAI for Database and Data Platform Operations** + Lead research, prototyping, and adoption of AI/GenAI to enhance database and data platform operations. + Design AI-driven capabilities for: + Predictive capacity and performance forecasting + Automated incident detection and triage + Query and workload optimization recommendations + Intelligent root cause analysis and log summarization + Develop AI copilots and natural-language tools to support database engineers and operations teams. + Integrate LLMs and ML models into observability platforms for real-time insights and self-healing actions. **Security, Compliance & Governance** + Ensure database platforms adhere to security best practices, regulatory requirements, and healthcare compliance standards (HIPAA, PHI). + Partner with Security and Risk teams to continuously assess vulnerabilities, access controls, encryption, and audit readiness. + Define governance standards for data access, retention, backup, and recovery across platforms. **Cost Optimization & FinOps for Data Platforms** + Lead cost transparency, optimization, and forecasting for cloud and on-prem database platforms. + Implement chargeback/showback models for database and analytics consumption. + Partner with Finance and stakeholders to optimize storage, compute, licensing, and usage patterns. + Analyze usage, utilization, and growth trends to reduce total cost of ownership. **Reporting, Metrics & Continuous Improvement** + Define and publish operational dashboards and executive-level reporting for data platform health, cost, and performance. + Analyze operational data to identify trends, risks, and improvement opportunities. + Drive standardization and platform consistency across teams to improve efficiency and reliability. + Act as a trusted advisor on data platform capabilities, limitations, and best practices. **AI / GenAI & Advanced Capabilities** + Experience or strong interest in AI/ML or GenAI applications for operational intelligence. + Familiarity with LLMs, vector databases, predictive analytics, or AI-driven monitoring solutions. Ability to move rapidly from concept → pilot → production for AI-enabled operational enhancements. **Use your skills to make an impact** **Required Qualifications:** + Bachelor's Degree + 10+ years of experience in database, data platform, or infrastructure engineering/operations, with 5+ years in a senior leadership role. + Deep hands-on experience with enterprise database and analytics platforms, such as: + SQL Server, PostgreSQL, MySQL + MongoDB or other NoSQL platforms + Snowflake, Databricks, or similar analytics platforms + Strong understanding of SRE, ITIL/ITSM, and operational best practices for data platforms. + Proven experience operating 24/7, high-availability, mission-critical systems. + Experience applying automation and infrastructure-as-code (Terraform, Ansible, scripting). + Advanced understanding of observability for data platforms (performance, capacity, query analysis). + Strong analytical, reporting, and stakeholder communication skills. + Experience integrating new technologies with existing technologies + Experience implementing technologies with enterprise-wide impact + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Familiarity with Agile methodologies + Healthcare industry experience + Cloud certifications (Azure, AWS, GCP) and/or database platform certifications + Experience with CI/CD pipelines for database and analytics platforms + ITIL, SRE, or Platform Engineering certifications **Additional Information** **Work-At-Home Requirements** + WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information\#LI-Remote 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. $142,300 - $195,700 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. **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 ***************************************************************************
    $142.3k-195.7k yearly 8d ago
  • Enrollment and Billing Specialist

    Unitedhealth Group Inc. 4.6company rating

    Lexington, KY job

    This position is Onsite. Our office is located at 230 LEXINGTON GREEN, Suite 400, Lexington, KY 40503. UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast-paced and highly diversified career. As an Enrollment Customer Service Representative, you will be responsible for administering union-sponsored benefits, including health and welfare and pension plans. Your duties will include verifying participant eligibility, responding to inquiries, preparing correspondence for members and employers, processing contributions and monthly checks, and reconciling reports to resolve discrepancies. This role requires strong analytical skills, proficiency in PC applications and Excel, and a commitment to improving processes for greater efficiency and quality. This position is full time (40hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm EST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 230 LEXINGTON GREEN, Suite 400, Lexington, KY 40503. Primary Responsibilities: * Administration of Union-Sponsored Benefits, including health and welfare, pension and others * Collection of data from participants to determine eligibility * Answer questions via telephone and email to convey information regarding the provisions of the pension and health and welfare plans. * Create various types of members or employer correspondence including letters and emails. * Collection and data entry of participant hours worked and contribution amounts. * Handle processing of monthly check processing and mailing * Analytical and Researching techniques. * Reconcile reports and payment discrepancies, analyze transactional data * Perform basic clerical functions with proficient PC and Excel Skill * Initiate and assist with developments/changes to increase or change quality and productivity. What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: * Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays * Medical Plan options along with participation in a Health Spending Account or a Health Saving account * Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage * 401(k) Savings Plan, Employee Stock Purchase Plan * Education Reimbursement * Employee Discounts * Employee Assistance Program * Employee Referral Bonus Program * Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) * More information can be downloaded at: ************************* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * High School Diploma / GED OR equivalent work experience * Must be 18 years of age OR older * 1+ years of experience working with billing reconciliation, posting deposits, and accounts receivable * 1+ years of experience in an office setting using the telephone and computer as the primary instruments for analyzing and solving customer problems and inquiries * Experience using Microsoft Excel (ability to create, edit, save, send, sort, filter, enter data, and use basic formulas in spreadsheets) * Experience with Microsoft Windows, including mouse and keyboard skills (data entry, open documents, save documents) including the ability to learn new and complex computer system applications. * Must work on-site at the office located at 230 LEXINGTON GREEN, Suite 400, Lexington, KY 40503 * Must reside within 90 miles of the office location 230 LEXINGTON GREEN, Suite 400, Lexington, KY 40503 * Ability to work our normal business hours of 8:00am - 5:00pm EST. It may be necessary, given the business need, to work occasional overtime or weekends. Preferred Qualifications: * Experience in finance / accounting area * Experience using Eligibility software * Experience of Taft - Hartley or Union Benefit Administration * Experience with reconciling bank accounts * Experience working with ERISA Compliant Benefit Funds * Experience working with healthcare insurance enrollment / eligibility Soft Skills: * Experience with working in a fast-paced multi-tasking environment * Detail Oriented, Quick Learner, Team Oriented * Good written and verbal communication skills * Good mathematical skill * Flexible * Self-Motivated * Strong organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.74 - $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED #RPOLinkedIn
    $17.7-31.6 hourly 7d ago
  • Lead Networx Analyst, Contract Configuration Info Mgmt

    Molina Healthcare 4.4company rating

    Lexington, KY job

    Provides lead level analyst support for configuration information management activities. Responsible for accurate and timely implementation and maintenance of critical information on claims databases, synchronizing operational and claims systems data and application of business rules as they apply to each database, validating data to be housed on databases, and ensuing adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements. **Essential Job Duties** - Analyzes and interprets data to determine appropriate configuration changes. - Accurately interprets specific state and/or federal benefits, in addition to other business requirements, and converts terms to configuration parameters. - Manages coding, updating and maintaining benefit plans, provider contracts, fee schedules and various system tables in the user interface. - Applies experience and knowledge to research and resolve claim/encounter issues and pended claims, and updates system(s) as necessary. - Loads and maintains contracts, benefit and/or reference table information into the claims payment system and other applicable systems. - Participates in defect resolution for assigned component(s). - Participates in the implementation and conversion of new and existing health plans. - Assists in planning and coordination of application upgrades and releases, including development and execution of some test plans. - Assists with development of configuration standards and best practices, and suggests improvement processes to ensure systems are working efficiently and enhance quality. - Creates reporting tools to enhance communication on configuration updates and initiatives. - Negotiates expected configuration information management completion dates with health plans. - Collaborates with internal and external stakeholders to understand business objectives and processes. - Solutions with health plans and corporate functions to ensure all end-to-end business requirements have been documented. - Assists leadership in establishing standards, guidelines, and best practices for the configuration information management team. - Represents as a departmental configuration information management subject matter expert. - Supports various department-wide configuration information management projects. - Provides training and support to new and existing configuration information management team members, including configuration functionality, enhancements and updates - Manages fluctuating volumes of work, and prioritizes work to meet deadlines and needs of the configuration department and user community. **Required Qualifications** + At least 5 years of configuration information management experience maintaining databases, and/or analyst experience within a health care operations setting in a managed care organization supporting Medicaid, Medicare, and/or Marketplace programs, or equivalent combination of relevant education and experience. + Must have Contract configuration experience in Networx. + Experience with QNXT is preferred. + Advanced experience using a claims processing system. + Advanced experienced verifying documentation related to updates/changes within a claims processing system. + Advanced experience validating and confirming information related to provider contracting, network management, credentialing, benefits, prior authorizations, fee schedules, and other business requirements. + Analytical and critical-thinking skills. + Flexibility to meet changing business requirements, and commitment to high-quality/on-time delivery + High attention to detail. + Effective verbal and written communication skills. + Microsoft Office suite proficiency, including intermediate to advanced Excel abilities (VLOOKUP/Pivot Tables, etc.), and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $80,168 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.2k-155.5k yearly 21d ago
  • Per Diem Staff Pharmacist

    Unitedhealth Group 4.6company rating

    Lexington, KY job

    **Explore opportunities with CPS** , part of the Optum family of businesses. We're dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind **Caring. Connecting. Growing together.** As a per diem Staff Pharmacist you'll play a vital role in delivering safe, accurate, and efficient pharmacy services. This is a hands-on opportunity to make a direct impact by ensuring the accuracy of medication orders, verifying technician-prepared products, and safeguarding controlled substances. You'll contribute to a high-performing team by mentoring new staff, maintaining seamless daily operations, and supporting the Director in optimizing pharmacy performance. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + ACPE-accredited pharmacy degree (PharmD preferred) + Active applicable state pharmacist license in good standing + 1+ years of recent pharmacist experience (hospital setting preferred) + Experience with pharmacy systems and Microsoft Office Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $94.52 to $162.07 per hour based on full-time employment. We comply with all minimum wage laws as applicable _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $69k-83k yearly est. 60d+ ago
  • Pharmacy Stars Improvement Lead

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **Become a part of our caring community and help us put health first** The Pharmacy Stars Improvement Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana's Stars patient safety measure performance. The Pharmacy Stars Improvement Lead will autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use with specific focus on telehealth and in-home methods of care delivery. The Pharmacy Stars Improvement Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree in Business, Finance, Health Care or a related field + 2 or more years of project leadership experience + Prior Medicare/Medicaid experience + Strategic thinking and planning capabilities; organized and detail-oriented + Excellent communication skills + Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written) + Ability to operate under tight deadlines + Successful track record in facilitating and consulting across teams and managing projects + Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need + Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data + Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint **Preferred Qualifications** + Master's Degree in Business Administration, Health Administration or a related field + Provider relations experience + Prior managed care experience + Understanding of metrics, trends and the ability to analyze and identify gaps in care + Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus + Understanding of CMS Stars and performance measure knowledge and experience a plus + Background working in quality improvements **Additional Information:** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work at home requirements:** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees 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 employees 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. **SSN Alert:** 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. 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. $104,000 - $143,000 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: 01-15-2026 **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 ***************************************************************************
    $104k-143k yearly Easy Apply 16d ago
  • Pension Enrollment and Eligibility Representative

    Unitedhealth Group Inc. 4.6company rating

    Lexington, KY job

    This position is Onsite. Our office is located at 230 Lexington Green, Suite 400, Lexington, KY 40503 OR 7440 Woodland Dr, Indianapolis, IN. UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career. What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: * Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays * Medical Plan options along with participation in a Health Spending Account or a Health Saving account * Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage * 401(k) Savings Plan, Employee Stock Purchase Plan * Education Reimbursement * Employee Discounts * Employee Assistance Program * Employee Referral Bonus Program * Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) * More information can be downloaded at: ************************* As a Pension Enrollment and Eligibility Representative, you will be responsible for administering union-sponsored pension plans. Key responsibilities include verifying participant eligibility, responding to inquiries, preparing correspondence for members and employers, processing contributions and monthly checks, and reconciling reports to resolve discrepancies. You will work directly with individuals preparing for retirement and retirees receiving pension benefits, ensuring accurate benefit calculations and providing clear guidance on plan provisions. Additional duties include processing retiree applications, monitoring contribution discrepancies, and maintaining compliance with ERISA and plan rules. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm EST. It may be necessary, given the business need, to work occasional overtime. Primary Responsibilities: * Administration of Union-Sponsored Benefits, including health and welfare and pension * Collection of data from participants to determine eligibility * Answer questions via telephone and email to convey information regarding the provisions of the pension and health and welfare plans. * Create various types of members or employer correspondence including letters and emails. * Collection and data entry of participant hours worked and contribution amounts. * Handle processing of monthly check processing and mailing * Analytical and Researching techniques. * Reconcile reports and payment discrepancies, analyze transactional data * Work directly with individuals preparing for retirement and those already retired who are receiving pension benefits, ensuring accurate benefit calculations and providing clear guidance on plan provisions. * Processing retiree applications, monitoring contribution discrepancies, and maintaining compliance with ERISA and plan rules. * Perform basic clerical functions with proficient PC and Excel Skills You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * High School Diploma / GED OR equivalent work experience * Must be 18 years of age OR older * 1+ years of experience in Pension Administration or a similar role, including responsibilities such as billing reconciliation, posting deposits, and managing accounts receivable. * 1+ years of experience in an office setting using the telephone and computer as the primary instruments for analyzing and solving customer problems and inquiries * Experience using Microsoft Excel (ability to create, edit, save, send, sort, filter, enter data, and use basic formulas in spreadsheets) * Experience with Microsoft Windows, including mouse and keyboard skills (data entry, open documents, save documents) including the ability to learn new and complex computer system applications. * Must work on-site at the office located at 230 Lexington Green, Suite 400, Lexington, KY 40503 OR 7440 Woodland Dr, Indianapolis, IN * Must reside within 90 miles of the office location 230 Lexington Green, Suite 400, Lexington, KY 40503 OR 7440 Woodland Dr, Indianapolis, IN * Ability to work our normal business hours of 8:00 AM - 5:00 PM EST. It may be necessary, given the business need, to work occasional overtime or weekends Preferred Qualifications: * Experience in finance / accounting area * Experience using Eligibility software * Experience of Taft - Hartley or Union Benefit Administration * Experience with reconciling bank accounts * Experience working with ERISA Compliant Benefit Funds * Experience with QuickBooks Soft Skills: * Experience with working in a fast - paced multi - tasking environment * Detail Oriented, Quick Learner, Team Oriented * Good written and verbal communication skills * Good mathematical skills * Flexible * Self-Motivated * Strong organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED #RPOLinkedIn
    $28k-31k yearly est. 28d ago
  • Senior Manager, MarketPoint Sales - Raleigh Durham, NC.

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **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. Are you passionate about the Medicare population, looking for a role in management with the ability to directly impact your own income potential? If so, we are looking for licensed, highly motivated and self-driven individuals to join our team. Our Senior Manager, Medicare Sales, motivates and drives a team of Medicare Sales Field Agents who sell individual health plan products and educate beneficiaries on our services in a field setting. Our teams also sell Life, Annuity, Indemnity, Dental, Vision, Prescription plans, and more. Humana has an inclusive and diverse culture welcoming candidates with multilingual skill sets to service our consumers. **This role is** **field** **based, and you will be out and about in the field in the Raleigh** **Durham, NC.** **area working with your team and meeting members face to face. You must reside in Raleigh** **Durham, NC.** **area or be willing to relocate to the area.** In this **field** position, you will; coach, mentor, educate, motivate and train a team of sales individuals. The Senior Manager, Medicare Sales, must have a solid understanding of the market they serve, how to resolve operational problems and provide creative solutions to increase sales while following CMS guidelines. This role also involves cultivating, maintaining, and building relationships with Humana's customers, both internal and external business partners, along with the community we serve through telephonic, virtual, and face-to-face interactions with individuals and groups. Other responsibilities include developing marketing budgets, and looking for branding opportunities. **Use your skills to make an impact** **Required Qualifications** + **Must reside in the** **Raleigh** **Durham, NC.** **area or be willing to relocate** + **Active Health & Life Insurance Licenses** + 2 or more years of sales leadership experience + 6 or more years of experience working in the insurance industry + Must be able to travel up to 50% of the time + Ability to lead a team of sales associates and train them in successful sales techniques, educational presentation skills, utilizing technology tools as well as building relationships with communities and medical providers + Strong aptitude for technology with proficiency in MS Office products, various CRM platforms, and various iPhone app capabilities + Must be a strong leader, strong producer + Strong organizational, interpersonal, communication and presentation skills + Ability to adapt and overcome when necessary + Community Engagement/Grassroots experience in marketing Medicare plans in the community + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits **Preferred Qualifications** + Bachelor's Degree + Prior experience working in Medicare and the health solutions industry + Engaged with the community through service, organizations, activities and volunteerism + Project management background or certification a plus + Bilingual with the ability to speak, read and write without limitations or assistance **Humana Perks:** Full time associates enjoy: + Base salary with a competitive commission structure + Medical, Dental, Vision and a variety of other supplemental insurances + Paid time off (PTO) & Paid Holidays + 401(k) retirement savings plan + Tuition reimbursement and/or scholarships for qualifying dependent children. + And much more! **Social Security Task:** Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website. **Virtual Pre-Screen:** As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes. \#MedicareSalesManager \#MedicareSalesReps 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. $77,000 - $105,100 per year This job is eligible for a commission 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: 01-30-2026 **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 ***************************************************************************
    $77k-105.1k yearly Easy Apply 32d ago
  • Analyst, Compliance (Sales)

    Molina Healthcare 4.4company rating

    Lexington, KY job

    **(Sales) Compliance Analyst** Molina Healthcare's Medicare Compliance team supports sales operations for the Molina Medicare product lines. It is a centralized corporate function supporting compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** is primarily responsible for Sales Oversight. · Provide regulatory expertise to the Sales Organization: both State and Federal · Have working knowledge of federal and state guidelines pertaining to Sales and Marketing. · Perform internal Sales/Marketing Compliance Reporting. · Perform internal Sales/Marketing monitoring. · Detailed oriented to conduct thorough Sales allegations investigations. · Recommend applicable corrective action(s) when applicable to business partners. · Process improvement driven. · Create, update, and retire P&Ps, Standard Operating Procedures and Training documents. · Lead regularly scheduled Sales & Compliance leadership meetings. · Interpret and analyze Medicare, Medicaid, and MMP Required Sales & Marketing Reporting Technical Specifications. · Create and maintain monthly and quarterly Sales Complaint Key Performance Indicator (KPI) reports. · Review and interpret internal Sales dashboards for outliers and deeper dive research. · Manage compliance Sales Allegations, Secret Shops, and recommend corrective action plans for deficiencies found. · Responds to legislative inquiries/ Sales complaints (state insurance regulators, Congressional, etc.). · Leads projects to achieve Sales compliance objectives. · Interprets and analyzes state and federal regulatory manuals and revisions. · Interpret and analyze federal and state rules and requirements for proposed & final rules for Sales Oversight. · Interact with Molina external customers, via verbal and written communication. · Ability to work independently and set priorities. **Experience** · 2-4 years' related compliance work experience · Exceptional communication skills, including presentation capabilities, both written and verbal. · Excellent interpersonal communication and oral and written communication skills. · High level Interaction with Leadership. · Sales Allegation Investigations · Policy & Procedures Pay Range: $80,168 - $116,835 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
    $80.2k-116.8k yearly 22d ago
  • Pharmacy Technician

    Walgreens 4.4company rating

    Lexington, KY job

    In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy. Assists the pharmacist in the performance of other Pharmacy Department duties in accordance with Company policies and procedures. Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions. If PTCB or ExCPT certified, assists with and coaches pharmacy technicians in the operation of pharmacy systems and cashiers in the operation of the pharmacy cash registers. Models and delivers a distinctive and delightful customer experience. Customer Experience Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer issues and answers questions to ensure a positive customer experience. Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). Develops strong relationships with most valuable customers. Operations Under the supervision by the pharmacist, assist in the practice of pharmacy, in accordance with state, federal, and company policy. Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct. Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly, filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions. Assists pharmacists in scheduling and maintaining work flow. Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities. Responsible and accountable for registering all related sales on assigned cash register, collects and handles cash as required. Takes customer to OTC aisle when possible to assist in locating products. Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager. Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals. Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs. May assist pharmacist in administering clinical services including the collection and proper labeling of blood/urine samples from patients and other clinical services as required; assists pharmacy staff in coordination of clinical services, Walgreens healthcare clinics and external providers. Assists Pharmacy Manager and Staff Pharmacist in developing and maintaining good relationships with the local medical community, including physicians, nurses, and other health care providers, by medical provider detailing and outreach to health groups, retirement homes, nursing homes, and other forums for enhancing growth opportunities. Assists with exterior and interior maintenance by ensuring the Pharmacy Department is stocked with adequate supplies, clean, neat and orderly in condition and appearance. Complies with all company policies and procedures; maintains respectful relationships with coworkers. Completes special assignments and other tasks as assigned. Training & Personal Development Earns and maintains PTCB or ExCPT certification through the designated PTCB training program and/or state required certification/registration. Otherwise, earns PTCB or ExCPT certification as condition of promotion to senior technician. Attends training and completes PPLs requested by Manager and acquires continuing education credits. Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments. Must be fluent in reading, writing, and speaking English. (Except in Puerto Rico) Requires willingness to work flexible schedule, including evening and weekend hours. Prefer six months of experience in a retail environment. Prefer to have prior work experience with Walgreens. Prefer good math skills so they can fill prescriptions accurately, including counting, measuring and weighing medications. Prefer good computer skills. Prefer the knowledge of store inventory control. Prefer PTCB or ExCPT certification. We will consider employment of qualified applicants with arrest and conviction records. The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
    $26k-30k yearly est. 60d+ ago
  • Inventory Specialist

    Walgreens 4.4company rating

    Lexington, KY job

    * Responsible for executing, monitoring, and training inventory best practices and standard operating procedures for the entire store, including both front end and pharmacy. Supports pharmacy inventory management activities, including receiving, counting, ordering, and facilitating returns. Champions On-Shelf Availability and is responsible for receiving, counting, pricing, returns, and all in-store inventory processes. Validates and ensures accuracy of planograms. * Responsible for reviewing and coordinating the proper use of reports and system applications, which have an impact on the accuracy of front end and pharmacy on-hand balances and pricing. * Responsible for executing and maintaining front end and pharmacy asset protection techniques, and filing claims for warehouse and vendor overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods including prescription drugs. * In designated stores, as required, opens and closes the store in the absence of store management, including all required systems start-ups, required cash handling and cashier responsibilities, and ensuring the floor and stock room are ready for the business day. Customer Experience * Engages customers by greeting them and offering assistance with products and services. In designated stores, when serving as the leader on duty, resolves customer issues and answers questions to ensure a positive customer experience. * Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.). Operations * Executes and coaches team members on warehouse and vendor inventory management processes including but not limited to creating, reviewing, and receiving orders. * Scans in all deliveries while the vendor is still in the store, including common carrier deliveries. Focuses on One Box receiving. Takes the appropriate action marking delivery as received if the product was physically delivered, contacting vendor for past undelivered scheduled receipts, and opening tickets as needed to correct inaccurate orders. * Under the supervision of the pharmacist-in-charge, verifies all pharmacy shipments are posted for products physically received at the store. Completes or verifies postings of all pharmacy warehouse orders, ABC prescription and OTC orders daily, secondary vendor orders, flu and dropship orders performing any necessary tote audits, and accurately reporting any shortages or damaged product. * Completes On-Shelf Availability (OSA) end-to-end process including warehouse and direct store delivery (DSD) for planogrammed departments, executing disposals, call-ins, and vendor returns before expiration, completes scan outs/ scan outs returns on all subscribed departments including vendor/ DSD departments and pharmacy scan outs. * Under the supervision of the pharmacist-in-charge,completes pharmacy inventory activities including but not limited to pharmacy recalls following Pharmacy Hazardous Waste Policy, vendor returns, non-controlled, and damaged salvage returns. Facilitates excess inventory returns or interstore pharmacy transfers where applicable for non-returnable ABC overstock. Verifies posting of all pharmacy/ prescription claims. * Completes execution of all pricing activities including price changes, markdowns, and markdowns deletes. Responsible for basic department pricing, including daily price changes, accurate pricing with correct signage, and reliable and timely completion of any additional regulatory pricing tasks. * Responsible for supporting front end and pharmacy ordering by ordering expense items. Monitors pharmacy manual orders to identify excess orders. Maintains consigned inventory and orders as required. * Ensures all designated pull & quarantine item on-hands are updated and placed in the designated holding area. * Maintains accurate inventory counts. Maintains the accuracy of on-hand quantities including but not limited to basic departments, stockroom, overstock locations. * Under the supervision of the pharmacist-in-charge, maintains accurate inventory counts and accuracy of on-hand quantities in pharmacy and completes pharmacy smart counts. * Ensures the store maintains inventory compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products). * Assists in the maintenance of inventory records, including receiving and posting of all products (in the front-end)) received at the store in all inventory systems. Organizes files and retains all invoices/receipts/return authorizations necessary for all inventory activities. * Helps to prepare for physical inventory and supports the physical inventory day activities, including but not limited to preparing sales floor, stockroom, and pharmacy for inventory and auditing the third party team on the day of inventory. * Supports keeping all counters and shelves clean and well merchandised. * Knowledgeable of all store systems and equipment. * Assists and coaches store team on all package delivery activities, including scanning in and out of packages, completing all daily inventory functions and, package returns at Walgreens. Supports execution of Pickup Program. * In designated stores, when serving as the leader on duty, responsible and accountable for registering all related sales on assigned point-of-sale system (POS), including records of scanning errors, price verifications, items not on file, price modifications, and voids. Completes product returns, order voids, customer refunds, cash drops to safe, and provides change as requested for point of sale. * Complies with all company policies and procedures; maintains respectful relationships with coworkers. * Completes any additional activities and other tasks as assigned. Training & Personal Development * Attends company-based trainings for continuous development and completes all e-learning modules including safety training requirements. * Obtains and maintains a valid pharmacy license/certification as required by the state. Communications * Serves as a liaison between management and non-management team members by coaching and developing other capabilities with inventory systems. When serving as the leader on duty, communicates assigned tasks to team members and reports disciplinary issues and customer complaints to management. Basic Qualifications * Six months of prior work experience with Walgreens (internal candidates) or one year of prior retail work experience (external candidates). * Must be fluent in reading, writing, and speaking English (except in Puerto Rico). * Must have a willingness to work a flexible schedule, including evening and weekend hours. * "Achieving expectations" rating on last performance review and no written disciplinary actions in the previous 12 months (internal candidates only). * Demonstrated attention to detail and ability to multi task and manage execution. * Experience in identifying operational issues and recommending and implementing strategies to resolve problems. Preferred Qualifications * Prefer previous experience as a shift lead, pharmacy technician, designated hitter, or customer service associate. * Prefer to have prior work experience with Walgreens, with an evaluation on file. We will consider employment of qualified applicants with arrest and conviction records. An Equal Opportunity Employer, including disability/veterans. The actual compensation that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits Salary Range: $17 - $20 / Hourly
    $17-20 hourly 51d ago
  • Home Infusion Nurse, Per Diem - Accredo - Lexington, KY

    Cigna Group 4.6company rating

    Lexington, KY job

    Home Infusion Registered Nurse - Accredo Specialty Pharmacy Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: Active RN license in the state where you'll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver's license Willingness to travel to patients' homes within a large geographic region Ability to do multiple patient visits per week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
    $49k-60k yearly est. Auto-Apply 60d+ ago
  • Associate Actuary, SPA-Rx

    Humana 4.8company rating

    Humana job in Frankfort, KY

    **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. _This a remote nationwide position_ 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. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + MAAA + Strong communication skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Prior Part D experience + Strong SAS skills + Prior Databricks experience **Our Hiring Process** As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. **Alert:** Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website. **_Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful._** \#LI-Remote 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: 01-29-2026 **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 ***************************************************************************
    $106.9k-147k yearly Easy Apply 23d ago

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