Remote Medicare Call Center Manager - Quality & Compliance

Humana Inc; Helena (MT); Remote; USD 70,000 - 143,000; Full time

Job summary

Humana Inc. is seeking a Manager, IFG Agnostic Call Center to lead the Medicare call center, ensuring SLAs, KPIs, and quality member interactions.

You will coach supervisors, monitor performance, and partner with Enrollment, Claims, Care Management, IT, and Legal teams to drive continuous improvement. Required: Active Health Insurance License, 2+ years of healthcare call center leadership, Medicare experience, CMS/HIPAA knowledge, and KPI management.

Qualifications

• Active Health Insurance License
• 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
• May require extended hours during Open Enrollment Period (OEP/AEP)
• Position will require quarterly travel

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
• 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
• Ensure consistent delivery of accurate, empathetic, and compliant member interactions
• Analyze call center metrics including AHT, FCR, CSAT, adherence, and utilization
• 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 experience

CMS regulations

KPI management

Open Enrollment involvement

Education

Bachelor's degree or equivalent

Job description

Humana Inc. is seeking a Manager, IFG Agnostic Call Center to lead the Medicare call center, ensuring SLAs, KPIs, and quality member interactions.

You will coach supervisors, monitor performance, and partner with Enrollment, Claims, Care Management, IT, and Legal teams to drive continuous improvement. Required: Active Health Insurance License, 2+ years of healthcare call center leadership, Medicare experience, CMS/HIPAA knowledge, and KPI management.