Remote Medicare Call Center Leader — Compliance & Quality

Humana; United States; Remote; USD 70,000 - 96,000; Full time

Benefits offered by this job

Commission incentive plan

Medical, dental and vision benefits

401(k) retirement savings

Paid time off

Job summary

Humana seeks an IFG Call Center Manager to lead the Medicare-focused contact center, driving service quality, CMS compliance, and performance excellence. You will oversee enrollment, eligibility, claims, and benefits inquiries while mentoring supervisors and agents.

Responsibilities include adherence to SLAs, staffing optimization, and continuous process improvements to enhance member satisfaction and CAHPS/STAR outcomes across Medicare Advantage and Part D programs.

Qualifications

• 2+ years of call center leadership experience in healthcare.
• 2+ years of Medicare (Medicare Advantage, Part D, or CMS-regulated environment) experience.
• Strong knowledge of CMS regulations, HIPAA, and Medicare compliance standards.
• Proven experience managing KPIs, quality programs, and high-volume operations.

Responsibilities

• Manage day-to-day operations of the Medicare call center, including inbound, outbound, enrollment, eligibility, claims, and benefits inquiries
• Ensure adherence to service level agreements (SLAs), KPIs, and productivity targets
• Monitor call volumes, staffing levels, schedules, and escalation processes
• Implement process improvements to increase efficiency and quality
• Ensure full compliance with CMS guidelines, Medicare regulations, HIPAA, and company policies
• Support CMS audits, internal audits, and compliance reviews
• Maintain documentation and workflows aligned to Medicare Advantage and Part D requirements
• Partner with Compliance and Legal teams to address regulatory updates
• Lead, coach, and mentor supervisors, team leads, and call center agents
• Conduct performance reviews, goal setting, and corrective action when needed
• Identify training needs and collaborate with Training teams to enhance Medicare knowledge and customer service skills
• Foster a culture of accountability, engagement, and continuous improvement
• Monitor quality assurance results and drive action plans for improvement
• Address member complaints, grievances, and escalations promptly and professionally
• Focus on improving CAHPS, STAR Ratings, and overall member satisfaction
• Prepare and present performance reports to senior leadership
• Use data to identify trends, risks, and opportunities for operational improvement
• Partner with Enrollment, Claims, Care Management, IT, and Provider Services
• Support open enrollment and other peak periods with staffing and workflow planning
• Participate in system enhancements, implementations, and process redesigns

Skills

Call center leadership

Medicare knowledge

CMS regulations & HIPAA

KPIs & quality programs

Job description

Humana seeks an IFG Call Center Manager to lead the Medicare-focused contact center, driving service quality, CMS compliance, and performance excellence. You will oversee enrollment, eligibility, claims, and benefits inquiries while mentoring supervisors and agents.

Responsibilities include adherence to SLAs, staffing optimization, and continuous process improvements to enhance member satisfaction and CAHPS/STAR outcomes across Medicare Advantage and Part D programs.