Jobs at Humana

Perform actuarial analytics and forecasting to model financial and market trends, support value-based care contracting and implementation, ensure data integrity, develop metrics and forecasts, troubleshoot data issues, and advise leadership to inform strategic and operational decisions.

Lead Product Owner translates product strategy and CMS interoperability/regulatory requirements into actionable backlogs for Agile teams. Primary focus on ePA APIs and FHIR-based interoperability, driving backlog prioritization, user story development, acceptance criteria, stakeholder alignment, and delivery execution. Serves as primary liaison among product, compliance, architecture, and engineering to ensure scalable, compliant solutions.

Lead pharmacy compliance for Medicare Part B and D by developing policies, interpreting regulatory/contract requirements, auditing PBM and dispensing operations, supporting regulator audits, conducting risk assessments, monitoring performance, and advising business units. Collaborate cross-functionally, present to regulators, and support remediation and continuous improvement efforts.

Design, build, and deploy LLM-based applications and multi-step AI workflows (retrieval, orchestration, agents) using large-scale structured and unstructured data. Partner with engineering to productionize solutions, implement evaluation and safety measures, ensure compliance and data governance, and communicate results to technical and non-technical stakeholders.

Partner with channel leadership to own performance reporting, dashboards, and scorecards; analyze KPIs, identify risks and opportunities, deliver data-driven insights, support forecasting, target-setting, and compensation measurement, and drive continuous improvement and reporting automation across the assigned sales channel.

Design, train, and evaluate reinforcement-learning policies for Humana's Next Best Action platform. Build and instrument large-scale training pipelines, ensure operation within clinical constraints, collaborate with data and platform engineers, diagnose policy failure modes, and deploy reliable production decision systems.

Lead product strategy and roadmap for Adobe Experience Platform to enable Next Best Action. Translate business and regulatory needs into product requirements, drive platform integrations, ensure data/consent governance, support cross-functional adoption, and measure KPIs to optimize personalization and activation across omnichannel touchpoints.

Builds and manages ETL processes and data pipelines in Azure Databricks using PySpark. Integrates data from multiple sources, tunes Spark and SQL for performance, troubleshoots pipeline failures, automates manual processes, and supports reporting and analytics to inform business decisions.

Serve as the Agile teams primary product decision-maker: define vision and roadmap, own and prioritize the backlog, translate needs into features and user stories with acceptance criteria, align stakeholders, balance tradeoffs, collaborate cross-functionally, support release and adoption, and use data and feedback to drive continuous improvement and influence departmental strategy.

Lead and manage AR/AP and patient billing operations for a multi-site primary and specialty care organization. Oversee denial management, claims follow-up, credit balance resolution, refunds, vendor partnerships, performance metrics, and process improvements while collaborating with clinical, compliance, contracting, and finance teams.

Manage utilization management nursing operations by applying clinical nursing knowledge to coordinate, document, and communicate care and benefit determinations. Interpret criteria, collaborate with providers and members, lead projects, supervise cross-departmental initiatives, and ensure appropriate treatment and resource allocation while supporting remote work and occasional travel.

Lead product strategy for member engagement, retention, loyalty, and lifecycle across digital and assisted channels. Own retention, NPS, engagement, and lifetime value outcomes; build roadmaps, business cases, and AI-enabled experiences. Partner cross-functionally, run large-scale initiatives, and develop a team of Product Managers to improve customer experience and drive growth.

Lead sourcing and category management for pharmaceutical and other supplier categories. Develop multi-year sourcing pipelines, supplier segmentation, risk-adjusted savings forecasts, and negotiation strategies. Ensure contract compliance, collaborate with continuous improvement, procurement operations, payables, and leadership to implement sustainable sourcing practices and mitigate commercial and legal risk.

Sell Humana ancillary Group benefits (Dental, Vision, Life, Disability) to employers (50+ lives). Build and maintain broker/consultant relationships, deliver presentations, negotiate, cross-sell, track activity in CRM, support post-sale enrollment, and collaborate with internal teams to drive territory growth and retention.

Lead stakeholder discovery and data-driven analysis for claims processes. Translate findings into system requirements, value propositions, business cases, and roadmap inputs. Document processes and requirements, perform cost-benefit and ROI analysis, partner with cross-functional teams, and communicate insights to influence decisions and support implementation.

Lead sourcing and category management for pharmaceutical and other supply categories. Develop multi-year sourcing pipelines, supplier segmentation, risk-adjusted savings forecasts, negotiate with vendors, ensure compliance, and partner with leadership and cross-functional teams to implement sourcing programs and supplier sustainability and compliance initiatives.

Analyze financial and operational drivers for Medicare Risk Adjustment; build, maintain, and document SQL and Excel analytical models; explain variances and trends; support financial reporting, projections, bids, budgets, and forecasts; and partner with Finance, Risk Adjustment Operations, Compliance, and analytics teams to ensure accuracy, controls, and actionable insights.

Lead analysis and improvement of authorization and referral claims processes by partnering with cross-functional teams, facilitating workshops, analyzing operational data, building dashboards and KPIs, translating business needs into technical requirements, ensuring scalability, compliance, and alignment with stakeholders.

Lead post-acute network management analytics and develop an alternative payment model. Ensure data integrity by building processes and controls, troubleshoot and root-cause data issues, collaborate with partners, advise executives on strategy, and analyze variables to guide decision-making.

Drive enterprise automation by identifying workflow inefficiencies across Home Health, Primary Care, and Pharmacy. Use data analysis, process and journey mapping, and MDM to define opportunities and leading indicators. Partner with product, engineering, clinical, compliance, and operations to design, validate, and scale AI-enabled automation solutions that improve outcomes and efficiency while ensuring regulatory compliance.