Jobs at Humana

Lead analytic efforts for Humana In-Home Programs: build member-level predictive models, forecasting, segmentation, and impact evaluations to improve engagement, close care gaps, and support HEDIS Stars performance. Partner with business, ops, and tech teams to deploy cloud-based ML solutions and present insights to senior leaders.

The Lead Data Engineer will oversee the architecture and operationalization of the Finance reporting data platform, focusing on Databricks, SQL, and Power BI. Responsibilities include designing scalable data solutions, optimizing data workflows, developing reporting datasets, implementing data quality frameworks, and leading data engineering projects.

The Director oversees and develops state-level pharmacy policy, driving advocacy efforts and cross-functional collaboration to influence legislative outcomes and support Humana's business objectives.

Develop and maintain value-based pro forma scenario and negotiation models, automate and standardize modeling, provide hands-on analytic support for IDN negotiations, collaborate with business partners on analytic solutions, and communicate results to stakeholders.

The Decision Intelligence Engineer will design and improve reinforcement learning policies for Humana's Next Best Action platform, focusing on decision-making algorithms, simulation environments, and training pipelines, while ensuring outputs align with clinical eligibility rules.

The Utilization Management Clinical Pharmacist 2 reviews medication authorizations, advises on cost-effective utilization, and ensures quality patient outcomes by analyzing care plans and usage patterns.

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.

Lead the development of Next Best Action strategies using Adobe Journey Optimization, ensuring personalized customer engagement through data-driven decisioning and content orchestration.

Lead design and enablement of scalable, reusable customer journey blueprints using Adobe Journey Optimizer. Collaborate with marketing, data science, IT, and agile pods to embed personalization, NBA decisioning, and multivariant testing; provide templates, governance, and documentation to accelerate pod execution and ensure compliant, measurable, enterprise-scale journeys.

Manage claims operations including customer contact, investigation, approval and settlement of claims. Work with insurers, providers, members and collections to resolve pending claims, exercise judgment in prioritizing and interpreting processes, and perform advanced administrative and operational support. Remote role with required virtual training and availability for weekday shifts in EST.

Lead pharmacy compliance efforts for Medicare Parts B and D, interpret regulatory guidance, perform audits and risk assessments, support PBM and dispensing operations, coordinate regulator audits, and collaborate across business units to monitor and remediate compliance risks.

Lead AI-driven reconciliation and automation to improve encounter data quality. Own model performance, identify root causes, partner with technical and business teams to enhance models, prioritize roadmap, and scale automation while communicating results to stakeholders.

Lead operational risk activities across business, Enterprise Risk, Regulatory Compliance, and Internal Audit. Conduct risk assessments, identify gaps/root causes, drive remediation, improve controls and processes, deliver data-driven reporting and visualizations, influence stakeholders, mentor teams, and support enterprise risk frameworks to improve compliance, efficiency, and member/provider experience.

Analyze and forecast financial, economic, and market data to support strategic and operational decisions. Develop premium variance reports, set monthly revenue targets, perform A:E analyses, expand explanatory driver interfaces, ensure data integrity and controls, troubleshoot anomalies, and collaborate with actuarial and finance partners.

Lead Product Designer responsible for driving user-centered mobile and web experiences across dashboards, navigation, search, and a shared design system. Partner with product, engineering, research, and content to translate insights into strategy, prototypes, and high-quality components. Lead workshops, evangelize design vision, ensure accessibility and standards, and guide teams through research, ideation, testing, and implementation within Agile delivery.

Configure and optimize Workday Payroll, Absence, and Time-Tracking workstreams; partner with Payroll, Benefits, and tech teams to define requirements, support integrations, provide tier-3 support, and improve the associate experience through business-process configuration and system stabilization.

Perform actuarial analysis and forecasting of financial, economic, and market data for Medicare Advantage underwriting margins. Own assumptions, perform reasonableness checks, troubleshoot data with suppliers, enhance claims/premium forecasting methodology, present monthly results to stakeholders, and extend models to additional lines of business.

Configure and maintain MyChart workflows (Care Companion, video visits, campaigns); translate clinical and business requirements into configuration; run design sessions; develop and execute system testing and UAT; manage defects and releases; support go-live readiness and cutover planning; maintain documentation and recommend process/configuration improvements to increase adoption.

Executive clinical leader responsible for strategy and operations of Utilization Management across Medicare and Medicaid. Integrates MDs, RNs, and nonclinical teams; oversees risk management, grievance and appeals, clinical contracting, vendor and dental review; leverages analytics, develops clinical talent, and drives improvements in Star Ratings and care outcomes.

The Associate Actuary analyzes financial data to support strategic decisions through metrics, data analyses, and model development, ensuring data integrity and enhancing complex models.