Humana

Risk

• Implement and advance data quality best practices using enterprise governance frameworks
• Align data quality practices to operational, business, and data governance needs of Humana Military
• Partner across business and technology teams to ensure data is accurate, consistent, reliable, and fit for use
• Support tools, processes, and data stewards to identify, monitor, and remediate data quality issues
• Establish data quality standards, measure and report on data quality performance, guide issue resolution efforts
• Drive collaboration among stakeholders to address root causes and strengthen upstream and downstream processes
• Support process improvement by enabling greater visibility into data issues and helping teams embed stronger quality controls into business operations

Data Governance Lead

Account Executive

• Achieve or exceed personal sales production expectations established by management.
• Develop and maintain multiple benefits brokerage relationships within assigned territory.
• Track all activities in company’s CRM system and keep current by updating account information regularly.
• Develop a clear understanding of our business and our diverse Group products.
• Collaborate with Ancillary Sales Executive and Ancillary Client Executive to expand broker/client relationship in assigned markets.
• Implement and support new sales initiatives developed by Humana to increase sales of existing products and/or develop sales of new products.
• Work closely with the market team to support, mentor and motivate the team to create a strong culture and drive positive results.

Small Group Sales Representative

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
• Advise regional leadership of functional strategies on matters of significance while exercising independent on complex issues

Market Finance Lead

Solutions Engineer

• be the senior individual contributor on a team with broad accountability across CenterWell's dispensing pharmacy portfolio
• own the architectural vision for complex, multi-system initiatives
• shape how technology decisions get made
• act as a connective force between business strategy, engineering execution, and enterprise standards
• lead solution design for major initiatives across the pharmacy business
• work closely with engineering leads, product managers, clinical stakeholders, and vendor partners
• to ensure technical decisions are sound, defensible, and aligned to long-term goals
• represent the architecture function in governance forums and executive reviews
• define and maintain architectural patterns and standards for the pharmacy technology portfolio
• lead architecture for high-complexity programs spanning dispensing systems, clinical platforms, integrations, and data

Lead Solutions Architect – CWP

Technical Project Manager

• Oversee various system projects and/or programs of a highly complex nature.
• Lead end-to-end project management for initiatives related to workflow automation and storage systems.
• Define project scope, objectives, and deliverables in collaboration with stakeholders and technical teams.
• Develop detailed project plans, schedules, and budgets; monitor progress and adjust as necessary.
• Identify and manage project risks, issues, and dependencies.
• Ensure project deliverables meet quality standards and comply with security, privacy, and regulatory requirements.

IT Project Manager

Medical Director

• Provide clinical interpretation and determinations on the medical appropriateness of services delivered by healthcare professionals, including the application of evidence-based guidelines.
• Make independent, timely, and defensible medical decisions on complex appeal cases, exercising professional judgment with minimal supervision.
• Collaborate with cross-functional teams—including legal, compliance, and clinical operations—to address and resolve grievances and appeals.
• Participate in quality improvement initiatives, identifying trends in grievances and appeals and recommending process improvements.
• Serve as a clinical resource for grievance and appeals staff, providing guidance and education as needed.
• Maintain current knowledge of Medicare regulations, managed care requirements, and industry best practices relevant to appeals and grievances.
• Support Humana’s commitment to continuous improvement in consumer experience, ensuring fair, consistent, and customer-focused outcomes.
• Participate in internal and external audits as required and respond to regulatory inquiries as needed.
• Adhere to all confidentiality and HIPAA requirements in handling protected health information (PHI).

Medical Director – Grievances & Appeals

Director

• Lead teams of nurses and behavior health professionals responsible for care management
• Oversee the assessment and evaluation of members' needs and requirements
• Guide the development, implementation, and evaluation of care management programs
• Facilitate effective communication and collaboration with internal and external stakeholders
• Lead the preparation and presentation of program reports
• Champion initiatives for process improvement and innovation

Associate Director – Care Management

• Design scalable, reusable, and modular solution architectures that can be adopted across multiple products and business domains.
• Apply a range of architectural tools and technologies—including AI and generative AI where appropriate—to meet business, experience, and operational needs.
• Define system interactions, service boundaries, data flows, and integration patterns across the digital ecosystem.
• Promote reuse of platform capabilities and reference architectures to reduce duplication and increase delivery velocity.
• Ensure solutions are secure, resilient, and production‑ready from day one.

Lead Solution Architect

IT Support

• Lead development and execution of enterprise architecture strategy aligned to business and digital transformation objectives.
• Establish target-state architecture models across infrastructure, networking, security, quality, and observability domains.
• Serve as a trusted advisor to senior executives, principals, and engineering teams.
• Drive enterprise-wide architecture governance, standards, reference architectures, and technology lifecycle management best practices.
• Facilitate architecture review boards (ARB), technology governance councils, and strategic planning forums.

Lead Enterprise Architect

Network Operations

• The Network Operations Coordinator 4 maintains provider data to support customer service activities through data integrity management and gathering of provider data needed for service operations.
• The Network Operations Coordinator 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.
• Manages provider audits, provider service and relations, credentialing, and contract management systems.
• Executes processes for intake and manage provider perceived service failures.
• Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals.

Network Operations Coordinator

Compliance

• Review Member Marketing and Communication materials to ensure compliance with CMS and state regulations
• Coordinate the filing of materials with CMS and state agencies
• Collaborate with teams, including Product, Marketing, Legal, Sales, and Compliance to ensure all materials are accurate, compliant, and documented
• Monitor regulatory changes and communicate updates to team members to ensure timely adaptation of materials and processes
• Maintain detailed records and documentation of compliance reviews and filings
• Support compliance audits and respond to regulatory inquiries related to marketing and communications
• Help with process improvement initiatives to strengthen compliance controls and efficiency

Insurance Product Compliance Professional

Strategy

• leads the execution of the IDN operating model by managing Service Operations Committee (SOC) forums
• synthesizing provider feedback into actionable insights
• drives cross-functional alignment across enterprise teams
• develops programs designed to drive value
• partners with leaders regarding implementation planning
• reviews and communicates results of programs
• advises executives to develop functional strategies on matters of significance
• exercises judgment on complex issues regarding job duties and related tasks

IDN Strategy Lead

Sales

• provides sales administrative support to assist with the acquisition or retention of customers
• work closely with assigned Sales Executives to support sales strategy, execution, and relationship management
• prepare sales materials, proposals, contracts, and reports
• support account planning through research on customers, prospects, and competitors
• respond to internal and external inquiries
• collaborate cross‑functionally to resolve issues and ensure timely follow‑through
• maintain up-to-date customer records
• understand department, segment, and organizational strategy and operating objectives

Group Medicare Sales Support Professional

• Serve as a subject matter expert and primary resource for ensuring Humana's Member Marketing and Communication materials follow all federal and state regulatory requirements
• Oversee compliance activities for insurance products focusing on comprehensive approval and filing of marketing and communication materials
• Mentor compliance associates and implement process improvement plans
• Engage directly with regulators and internal leadership to guide compliance excellence
• Oversee the review of Member Marketing and Communication materials for compliance with CMS and State regulations
• Implement filing of materials with CMS and State agencies
• Be the primary liaison with internal teams (Product, Marketing, Legal, Sales) and external regulatory bodies for compliance matters
• Monitor and interpret regulatory changes providing strategic guidance

Senior Insurance Product Compliance Professional

Project Manager

• Oversee and drive the successful planning, execution, and delivery of IT Programs/Projects at Humana.
• Manage a team of project managers, ensuring projects are aligned with organizational objectives, delivered on schedule, and within scope and budget.
• Collaborate with stakeholders across IT, business units, and vendors to foster effective communication, risk mitigation, and continuous improvement.
• Optimize resource allocation across projects, balancing capacity, skills, and business priorities.
• Track and report on project and program performance using key metrics.
• Ensure adherence to corporate policies, regulatory requirements, and governance frameworks for all projects.