Encounter Data Lead – AI & Automation

Humana

AI and automation lead improving encounter data quality for Humana, a U.S. healthcare company.

Posted 8/10/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $94,900 - $130,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in leading AI-driven reconciliation initiatives and improving model performance within a healthcare environment. Proficient in analyzing complex data issues and collaborating with technical teams to enhance AI models and automation processes.

Highest-signal resume keywords

AI Model Performance MonitoringHealthcare ExperienceProject LeadershipData Analysis for Process ImprovementAI/ML Tools and Automation Technologies

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

AI Model DevelopmentMachine LearningData AnalysisProcess AutomationError Trend AnalysisReconciliation Process ImprovementRoot Cause AnalysisPerformance EvaluationData Quality AssessmentTechnical Communication

Soft Skills

CollaborationProblem SolvingDecision MakingClear CommunicationStakeholder Engagement

Tools & Technologies

AI/ML ToolsData PlatformsAutomation TechnologiesClaims Adjudication SystemsEncounter Submission Platforms

Industry Keywords

Healthcare EnvironmentEncounter Data ManagementPHI/HIPAA ComplianceProcess TransformationAutomation Initiatives

About the role

Key responsibilities & impact

Lead AI-driven reconciliation and automation initiatives to improve encounter data accuracy and efficiency
Own the performance and continuous improvement of AI models used in reconciliation processes
Monitor and evaluate AI model performance, reconciliation rates, error trends, and data quality outcomes
Identify gaps and partner with technical teams to enhance models and improve results
Analyze complex data issues and use AI-driven insights to determine root causes and solutions
Collaborate with business and technical partners to prioritize enhancements and automation opportunities
Communicate AI performance, risks, and progress to stakeholders in a clear, actionable way
Maintain and prioritize a roadmap of AI improvements, backlog items, and automation initiatives
Work independently to solve complex problems and make decisions based on data and business impact
Report to the Director, Encounter Data Management
Attend occasional travel to Humana offices for training or meetings

Requirements

What you’ll need

4+ years of experience working with AI or machine learning models, including monitoring and improving model performance
4+ years of experience working in a healthcare environment
2+ years of project or program leadership experience
Experience using data to identify trends, solve problems, and improve processes
Ability to work across teams and communicate technical concepts to non-technical audiences
Experience working with AI/ML tools, data platforms, or automation technologies preferred
Familiarity with claims adjudication systems (CAS) or encounter submission platforms such as Edifecs preferred
Experience supporting or partnering with data science teams preferred
Background in process automation or transformation initiatives preferred
Ability to provide a high-speed DSL or cable modem for a home office
Minimum internet speed of 25 Mbps download and 10 Mbps upload
Satellite and wireless internet service is not allowed
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Internet expense payment for associates or contractors who live and work from home in California
Remote work arrangement
Home office internet requirements support