Humana

Operations

• Lead enterprise oversight of Medicare market operational and financial performance across multiple geographies.
• Drive accountability for membership growth, medical cost performance, quality outcomes, and operating margin.
• Translate large-scale operational, financial, and clinical data into strategic insights and market interventions.
• Identify emerging trends in medical cost, utilization, risk adjustment, and member engagement and deploy targeted performance improvement strategies.
• Partner with finance and actuarial leaders to manage Medical Loss Ratio, administrative cost efficiency and margin improvement.
• Align operational priorities across the enterprise to ensure consistent delivery of Medicare strategy at the market level.
• Monitor competitive market dynamics, regulatory developments, and demographic trends affecting Medicare markets.
• Build and lead a high-performing team responsible for Medicare market analytics, operational strategy, and performance governance.
• Foster a culture centered on accountability, transparency, and data-driven decision making.

VP, Medicare Market Operations – Business Performance

Data Engineer

• Responsible for designing, generating, and validating high-quality artificial member data to support testing, analytics, and system integration
• Building synthetic data scenarios using tools such as GenRocket
• Overseeing the end-to-end data lifecycle—from EDI intake through transformation, validation, and integration into downstream platforms
• Collaborating with business and technical partners to deliver reliable, compliant, and test-ready data assets
• Identifying opportunities to improve data generation, validation, and integration processes
• Operating within Humana's enterprise data governance, security, and architectural standards

Data Engineer, Synthetic Data Generation

Marketing

• Lead the strategic oversight and continuous optimization of the live agent channels for marketing campaigns to improve member health outcomes, including both dedicated campaign call centers and Humana’s general customer service
• Collaborate with cross-functional teams to forecast call volume, managing timing of outreaches, and plan capacity and resources
• Champion the voice of the members by listening to calls for quality and insights, integrating feedback, and enhancing engagements using behavioral signals
• Partner with call centers to ensure they have the data they need to deliver personalized support to members on key health topics
• Collaborate on strategic projects to improve data and technology integration with call centers, including data exchanges, technology advancements, and operational improvements
• Develop and refine test-and-learn strategies, including hypotheses, measurement plans, and performance goals
• Execute and optimize multi-channel campaigns (email, mail, SMS, app, web, call center, IVR) across all engagement areas
• Support journey mapping and personalization efforts, including NBA (Next Best Action) logic and content orchestration
• Participate in agile pod operations, including sprint planning, backlog grooming, and tracking deliverables.
• Monitor operational performance to help enable efficient program delivery
• Lead performance tracking, outcomes reporting and analyses of live agent channels to inform strategic decisions and roadmap iterations.

Lead, Engagement Marketing – Telephonic Channels

Paralegal

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Strategy

• Leads execution of one complex workstream (or multiple, less complex workstreams) with limited oversight
• Develops initiative-level workplans and manages outcome-based delivery
• Solves problems creatively : produces strategies and executes against specific deliverables independently
• Generates data-based insights and action plans
• Creates compelling executive-level written communication
• Establishes trust-based relationships with business; seen as an emerging expert in specific focus areas
• Contributes to a positive and collaborative working and learning environment

Transformation Strategy Lead

Security Engineer

• Partner with the Product Security leadership to ready requests from numerous sources into a prioritized, deliverable backlog for the team
• Communicate the priorities and execution status effectively to key stakeholders
• Incorporate stakeholder input into backlog while effectively negotiating tradeoffs of conflicting priorities based on value to the business and customer
• Collaborate with the Product Security Director, Associate Directors, stakeholders, other Product Security and dependent teams to align on priorities, set commitments and prioritize the backlog
• Drive quality and innovation into the team's work product
• Define key metrics for relevant reporting on status
• Own messaging of status and health of the team's delivery ensuring that the work meets the customers' needs
• Facilitate activities and sessions such as Backlog Refinement
• Follow established guidelines/procedures.

Product Owner – Cybersecurity

Financial Planning and Analysis

• collects, analyze and report on market data to connect financial outcomes with operational effectiveness
• review Market Financials, Claims and trend analytics, reviewing contract financials, and budget/administration development
• Work with Actuary, MRA, Corporate Finance, Clinical, Market Point and Providers/Hospitals/Ancillary internally
• Work with our Value Based Providers relating financials, membership, cost and utilization reporting
• Promote optimization inclusive of activities spanning decisions Strategic planning and addressing specific performance issues across and relationships Company Initiative
• Advise regional leadership of functional strategies on matters of significance while exercising independent on complex issues

Market Finance Lead

Designer

• Support visioning and concept development projects, assisting with user research, analysis and synthesis, concept ideation, prototyping and testing, and implementation planning.
• Contribute to the design and delivery of components integral to communicating our work, e.g., service blueprints, low- and mid-fidelity prototypes, frameworks, concept illustrations, slides.
• Collaborate with UX/UI designers, product teams, marketing, and operations to ensure seamless integration between digital tools and offline touchpoints.
• Demonstrate ability to listen and to thoughtfully contribute to business stakeholder and channel partner team conversations, strengthening our ability to deliver through cross-enterprise collaboration.
• Stay informed about industry trends in health insurance, digital health, and service design best practices.

Service Designer

• Lead development of new service experiences, including problem framing, user research, analysis and synthesis, concept ideation, prototyping and testing, and implementation planning.
• Create service blueprints, low- and mid-fidelity prototypes, frameworks, concept illustrations, and stories that make fuzzy concepts tangible to our stakeholders, partners, and customers.
• Collaborate with UX/UI designers, product teams, marketing, and operations to ensure seamless integration between digital tools and offline touchpoints.
• Demonstrate ability to listen, contribute to, and thoughtfully facilitate business stakeholder and channel partner team conversations, strengthening our ability to deliver through cross enterprise collaboration.
• Contribute to the continuous development of the design discipline, engaging in activities and exploring new tools that help us learn, practice, and evolve our practice to improve quality and efficiency.

Senior Service Designer

• report to an Associate VP of Strategy Advancement
• drive ecosystem strategy, identifying architecture simplifications, provider data quality improvements, operational and quality automations
• deliver end to end efficiency, quality and modernization through automations, operational processes and product technology strategies
• manage provider data business intelligence
• partner across Humana Military products, IT, automation teams and business partners on data stewardship and data models
• initiate strategies to leverage new technologies to improve provider data quality
• manage UAT processes and automations
• ensure quality programs monitor adherence to TRICARE policies
• monitor provider data incident, escalation and resolution processes

Director, Process Improvement

Manager

• Assess members, focusing on health and safety needs, to develop a comprehensive Member Care Plan (MCP)
• Conduct regular health assessments
• Coordinate with acute and primary care providers
• Educate members on disease processes and related risks, nutrition, exercise and lifestyle modifications
• Document in member files within required DHS contract timeframes
• Participate in member monthly phone contacts and travel to attend in person visits in members setting
• Work remotely from your home and travel approximately 40% of the time

Registered Nurse – Care Manager

• reports to the Quality Assurance Manager and supports the home health branch operations by developing educational content and ongoing training programs for staff.
• Create annual training modules, guides, and resources for learning and development.
• lead performance improvement projects, using data and feedback to accomplish quality outcomes.
• evaluate educational effectiveness, support compliance efforts, and facilitate communication across clinical and administrative teams.
• collaborate with the Learning & Development team to ensure understanding of organizational standards and regulatory requirements.

Learning Design Professional

Auditor

• Conduct comprehensive audits of professional evaluation and management services, inpatient, emergency room, minor procedures, consultation services, and annual wellness service encounters
• Review and analyze provider documentation for completeness and accuracy to ensure proper code assignment in accordance with CPT, HCPCS, ICD-10-CM, and CMS guidelines
• Utilize various encoders and coding tools/resources (e.g., decisionhealth, 3M, AMA, CMS) to validate code selection and support audit findings
• Prepare detailed audit reports, summarizing findings, trends, and recommendations for education or process improvement
• Remain current with changes in coding guidelines, payer policies, and industry trends impacting Evaluation & Management services
• Assist with internal and external audit responses and appeals as needed
• Support compliance initiatives and contribute to ongoing process improvement within the coding and auditing team

Medical Coding Auditor – Evaluation & Management

Pharmacist

• Responsible for state policy portfolio including pharmacist licensure, pharmacy shares services, PBM, occupational/facility licensure, and federal preemption.
• Analyze, define and communicate critical trends in state legislative and regulatory environments; track state legislation of interest; identify or predict probable legislative or regulatory outcomes.
• Develop regulatory and legislative responses to proposed rules/laws including regulatory comment letters, issue briefs, talking points, white papers, and PowerPoint presentations.
• Counsel Humana businesses on state public policy risks/opportunities and translating those into clear business impact analysis.
• Work with internal business partners to identify assets Humana has to augment public policy positions such as: data; resources; subject matter experts; and 'thought leaders'.
• Leverage experience and relationships to support advocacy efforts with state government officials and regulators with specific focus on state boards of pharmacies and National Association of Boards of Pharmacy.

Director, State Public Policy – Pharmacy, Pharmacy Benefit Management

Analyst

• Supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals
• Analyzes provider financial patterns and trends utilizing excel and/or SQL
• Updates, maintains, and reviews fee scheduling and pricing structures
• Thoroughly reviews provider contracts and ensures rates are priced and applied accurately
• Identifies process recommendations and ensures compliance with government regulations
• Collaborates and communicates with internal partners of all professional levels within various departments