Health Care Service Corporation

Review AI-generated transcripts and behavioral insights from service calls to identify and escalate incorrect or misleading information. | Bachelor's degree, 2 years in health insurance operations, experience with AI/ML systems and call quality monitoring, familiarity with HIPAA, and strong analytical and communication skills. | At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This role is responsible for reviewing A-I generated transcripts, summaries, and behavioral insights from member/provider service calls to identify and escalate instances of incorrect or misleading information shared with the caller. Required Experience • Bachelor's Degree and 2 years of experience in health insurance operations, with strong knowledge of medical benefits, claims processing, and member communications. • Experience with AI/ML systems, transcription tools, or customer service analytics platforms. • Experience in call quality monitoring or auditing strongly preferred. • Strong analytical and critical thinking skills with a high attention to detail. • Comfort interpreting and validating AI-generated content (transcripts, summaries, and sentiment/behavioral scoring). • Familiarity with HIPAA and related compliance standards. • Excellent written and verbal communication skills. Preferred Experience • Background in health plan regulatory compliance, training, or quality improvement. Certification in healthcare claims or auditing (e.g., CPC, CPMA) is a plus. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! EEO Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Pay Transparency Statement: At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Min to Max Range: $48,500.00 - $91,000.00 Exact compensation may vary based on skills, experience, and location.

Manage specialty diabetes cases through care coordination, member education, and liaison with healthcare providers to promote quality and cost-effective outcomes. | Must be a licensed RN with 4 years clinical practice including 3 years specialty diabetes experience, current CDE/CDCES certification, and knowledge of clinical care coordination and management. | At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position's primary focus is the management of members with specialty (Diabetes) diagnoses. This position will be responsible for performing all functions of case management (CM) and is a primary source of contact for members, health care personnel and all other entities involved in managing specialty care. The primary nurse case administrator performs care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost- effective outcomes; and serves as liaison to physicians and members. Provide education/local resource information and encourage member (self) education functioning in a clinical care advisory role. The primary nurse case administrator assesses members for case management, introduces members to our website tools, educates members regarding their specific condition, and facilitates the coordination of care for identified members. JOB REQUIREMENTS: • Registered Nurse (RN) with current, valid, unrestricted license in state of operations • 4 years clinical practice experience of direct clinical care, to include 3 years of recent Specialty (Diabetes) clinical experience • Knowledge of specialty diagnosis drugs, adjunct therapies and treatment protocols including side effects and complications • Current certification in one of the following: CDE/CDCES • PC proficiency to include Word, Excel, and database experience • Clear and concise verbal and written communication skills • Knowledge of UM/CM/DM activities and standardized criteria set • Familiarity of ancillary services including HHC, SNF, Hospice, etc. • Verbal and written communication skills; analytical skills; sound clinical judgment • Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. • Knowledge of drugs and treatment protocols including side effects and complications • Knowledge of diets relating to assist members • Knowledge of Problem Solving, Healthy Coping and establishing SMART goals. • Current Certified Specialists must maintain their certification PREFERRED JOB REQUIREMENTS: • RN Compact license required • Experience in managing complex or catastrophic health cases • Inpatient and Outpatient experience preferred. • 1-year experience in Care Management in a health insurance/managed care setting • Current CCM certification • Knowledge of medical management policies and procedures • 1-year education experience in Specialty area "This role will telecommute full time TX. Applicants in AR and LA will also be considered so long as they are within a 250-mile radius from posted location and hold a current compact nursing license." #LI-Remote #LI- DP1 #CA #INAK Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$69,200.00 - $146,700.00 Exact compensation may vary based on skills, experience, and location.

Negotiate renewals or sell products and services to existing customers while understanding customer needs and providing support. | Must have or obtain state General Lines Agent Life, Health, and HMO license, 2-4 years healthcare management or related experience, strong customer service and communication skills, and ability to travel. | At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. This position is responsible for ensuring continued and increased growth by negotiating renewals or selling products and services to existing customers, understanding customer needs, and providing customer support. Ability and willingness to travel, including overnight stays. JOB REQUIREMENTS: *Must have state General Lines Agent Life, Health, and HMO license or obtain General Lines Agent Life, Health, and HMO license within required time frame per state regulations. *4 years experience in a health care management field, claims processing, customer service or marketing/ sales involving decision making, self-direction, and finance/product analysis OR Bachelor degree and 2 years health care management, customer service or marketing/sales experience. *Health care management work experience including PPO and HMO. *Customer Service oriented; detail oriented. *Written and verbal communications skills. *Ability to travel *Experience addressing customer needs and make sound decisions; building strong customer relations. *Experience analyzing reports. PREFERRED JOB REQUIREMENTS: *Bachelor Degree. Compensation: $55,800.00 - $83,600.00 Exact compensation may vary based on skills, experience, and location HCSC Employment Statement We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. To learn more about available benefits, please click https://careers.hcsc.com/totalrewards

Lead actuarial valuation and financial reporting for Medicare Supplement products, manage actuarial team, and ensure compliance with regulatory and financial standards. | Bachelor's degree in actuarial or related field, FSA or 4 years ASA-level actuarial experience, 7+ years in health insurance actuarial roles, strong communication and PC skills. | At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. This position leads HealthSpring Supplemental Benefits (HSB)’s Valuation team and related ongoing financial reporting functions. HSB is a profitably growing division selling Medicare Supplement and other Supplemental Health and Life products. Current annual revenues are $1.5B, with total liability/DAC balances of approximately $1B. Responsibilities • Serve as Appointed Actuary for HSB Legal Entities, coordinating all annual actuarial statement deliverables. • Establish monthly balances for claim and policy liabilities/assets including IBNR, UEP, ALR, and DAC. • Determine and explain drivers of earnings variances related to premium, claims, and reserves on a monthly cycle. • Complete testing related to Stat and GAAP reporting requirements including Annual Statement reporting, Cash Flow Testing, DAC Recoverability Testing, and Loss Recognition Testing. • Update and implement reserving/financial processes to coincide with new product and Medicare Supplement charter launches. • Own and execute Sarbanes-Oxley controls and other governance processes. • Lead project management of FASB Long Duration Targeted Improvements including methodology/process changes, understanding impacts, annual unlocking and communication of impacts. • Lead actuarial valuation team and effective ongoing management of valuation functions. Coach and develop talent across team of actuaries and financial analysts. • Partner with other leaders in Actuarial team and across HSB to drive towards successful outcomes and achievement of strategic objectives. Develop and provide unique insights that support and enable achievement of such goals. Required Job Qualifications • Bachelor degree in Actuarial Science, Mathematics, Statistics or Economics. Other Bachelor (or higher) Degrees may be considered. • Fellow of the Society of Actuaries (FSA) and Membership in the American Academy of Actuaries (MAAA). In place of attainment of FSA, 4 years of actuarial experience in the health insurance field at the ASA level may be substituted. Compliance with all the membership requirements for each professional designation. • At least 7 years of actuarial experience in the health insurance or related field. • Verbal and written communications skills to prepare effective documentation, facilitate training and development, and participate in presentations. • PC proficiency to include Word and Excel. Preferred Job Qualifications • Experience with valuation • Experience with Medicare Supplemental health and life product • This is a hybrid role, in the designated office 3 days/week Compensation: $130,800.00 - $242,800.00 Exact compensation may vary based on skills, experience, and location HCSC Employment Statement We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. To learn more about available benefits, please click https://careers.hcsc.com/totalrewards

Serve as a strategic HR consultant partnering with business leaders on workforce planning, organizational change, talent initiatives, and cultural transformation. | Bachelor's degree, 7+ years HRBP or HR generalist experience, knowledge of employment laws, strategic thinking, data-driven decision making, and strong relationship building. | At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary BASIC FUNCTION As the Senior HRBP you will serve as a strategic thought partner to our leaders. You will become deeply embedded in their business priorities, influencing decisions related to organizational design, leadership effectiveness, and talent initiatives. You will partner with the HRBP Director in gathering appropriate information to respond to the HR needs of the division(s) supported. Identify opportunities to support business objectives with people implications; and participate in facilitating HR / business related change, and cultural transformation initiatives across assigned business units. NOTE: This is a hybrid role (3 days on-site per week). Relocation is not available, sponsorship will NOT be offered ~ JOB REQUIREMENTS: • Bachelor's degree and 7 years of HRBP or HR generalist experience OR 11 years in a similar role. • Experience directly partnering with business leaders on talent, culture, and organizational change. • Knowledge of federal, state and local employment and labor laws. • Strategic thinker, problem solving and analytical skills. • Experience using and presenting data to inform decision-making (Excel proficiency a must). • Strong relationship building skills and ability to influence without authority. • Keen attention to detail and follow through. • Self-driven, autonomous, and a team player. ~ KEYRESPONSIBILITIES ~ • Serves as a strategic HR consultant with emphasis in supporting the creation and implementation of the divisions' Workforce Plans. • Acts as subject matter expert in tools, technologies and methodologies to support business customers; and provides indirect leadership and mentoring of peers. • Exhibits a general knowledge of all areas of HR to include Compensation, Talent Acquisition, Benefits, Workforce Relations, Talent Management, and Learning and Development. • Embeds with client group to maintain strong knowledge of current and future challenges and opportunities. • Proactive to the business needs through directly working with the Centers of Excellence in gathering pertinent information required in supporting the workforce and the HR strategies of the division. • Leverages data to diagnose organizational health and influence decisions around team effectiveness, retention, engagement, and performance. • Identify opportunities in which HR can partner to support business objectives with people implications. • Facilitates cultural transformation and complex transitions, including restructuring, and cross-functional change, ensuring strong change management. • Maintains complete confidentiality of company business and demonstrate strong attention to detail. • Maintains communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested. • Complies with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and all applicable corporate and departmental policies. PREFERRED JOB REQUIREMENTS: • Master's Degree • Professional HR certification • Experience in technology organizations, supporting Information Technology, Information Security, Engineering, Digital Solutions, AI/Automation and/or Product #LI-TP1 #LI-Hybrid Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $90,900.00 - $164,200.00

Manage and develop network strategy for Government Programs and Provider/Vendor Networks, lead contract negotiations, and manage direct staff. | Bachelor's degree with 4+ years healthcare administration/managed care experience, expertise in managed care contracting and benefits administration, leadership and negotiation skills, and ability to travel. | At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for managing, developing and maintaining the network strategy for Government Programs, Provider/Vendor Networks; ensuring new and renewed contracts meet enterprise pricing and methodology standards, meet/exceed CMS & or State Network Adequacy requirements. This position is responsible for management of direct staff. This position is responsible for leading contract negotiations and developing and maintaining relationships with providers/vendors. REQUIRED QUALIFICATIONS: • Bachelor's degree and 4 years health care administration/managed care experience OR 8 years health care administration/managed care experience • 4 years' experience in managed care contracting, benefits administration or underwriting experience including contract negotiations • Leadership skills • Verbal and written communication skills to interact with all levels of corporate personnel and assigned providers • Analytical skills and reporting experience • Planning skills • Negotiation skills • Experience consistently meeting deadlines and working well under pressure • PC proficiency including Word, Excel, PowerPoint and databases • Experience developing and analyzing reports • Team player and people oriented • Ability and willingness to travel, including overnight stays PREFERRED JOB QUALIFICATIONS: • Experience working with providers. • Triwest/ Tricare experience. • Experience working with Government Program products and knowledge of the CMS Stars rating system. • Experience and skilled in developing contract standards for pricing and methodology. • Experience working with Government Programs risk and capitated based provider contracts. #LI-Hybrid #LI-DR2 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards. The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan. HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$90,900.00 - $164,200.00