Manager, Agnostic Call Center

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the daily operations of the Medicare call center, which includes managing inbound and outbound calls, enrollment processes, eligibility checks, claims handling, and benefits inquiries.

• Ensure compliance with service level agreements (SLAs), key performance indicators (KPIs), and productivity goals.

• Monitor call volumes, staffing requirements, schedules, and escalation protocols.

• Implement process enhancements to boost efficiency and service quality.

• Guarantee adherence to CMS guidelines, Medicare regulations, HIPAA, and organizational policies.

• Assist with CMS audits, internal audits, and compliance evaluations.

• Maintain documentation and workflows that align with Medicare Advantage and Part D standards.

• Collaborate with Compliance and Legal teams on updates related to regulations.

• Lead, coach, and mentor supervisors, team leaders, and call center representatives.

• Conduct performance evaluations, set goals, and implement corrective actions.

• Identify training requirements and work together with Training teams.

• Promote accountability, engagement, and ongoing improvement.

• Review quality assurance outcomes and initiate improvement action plans.

• Address member complaints, grievances, and escalations effectively.

• Enhance CAHPS, STAR Ratings, and overall member satisfaction.

• Ensure that member interactions are accurate, empathetic, and compliant.

• Analyze metrics such as average handling time (AHT), first contact resolution (FCR), customer satisfaction (CSAT), adherence, and utilization.

• Prepare and deliver performance reports to senior leadership.

• Identify trends, risks, and opportunities for operational improvement.

• Collaborate with Enrollment, Claims, Care Management, IT, and Provider Services teams.

• Provide support during open enrollment and peak periods with staffing and workflow strategies.

• Participate in system enhancements, implementations, and process redesign initiatives.

⛳️ Requirements

• Possession of an active Health Insurance License.

• A minimum of 2 years of leadership experience in a healthcare call center.

• At least 2 years of experience in Medicare (including Medicare Advantage, Part D, or a CMS-regulated environment).

• Solid understanding of CMS regulations, HIPAA, and Medicare compliance standards.

• Proven track record in managing KPIs, quality initiatives, and high-volume operations.

• Availability for extended hours during the Open Enrollment Period (OEP/AEP).

• This position will require quarterly travel.

• A Bachelor’s degree or equivalent experience is preferred.

• Background in managed care or health plan call centers is preferred.

• Experience in call center workforce management is preferred.

• Familiarity with Lean, Six Sigma, or process improvement methodologies is preferred.

• A minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information is essential.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Additional whole-person well-being and wellness opportunities.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.