Humana

Compliance

• Researches, analyzes, assesses risk and consults on rules, regulations and sub-regulatory guidance that apply to Insurance Products
• Works on problems of diverse scope and complexity ranging from moderate to substantial
• Partners with internal stakeholders and serves as Humana liaison while drafting, filing and negotiating approval with state and federal regulators for service area expansions and product-specific documents
• Supports implementation and maintenance of compliant insurance products in collaboration with responsible business owners
• Advises executives to develop functional strategies on matters of significance
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision
• Uses independent judgment requiring analysis of variable factors and determining the best course of action

Insurance Product Compliance Lead

Actuary

• The Actuary, Pricing sets pricing assumptions, submits bids, files and gains approval of premium rates and rate certifications with regulatory agencies.
• You will support implementation of rates, new plans and benefit changes.
• You will provide guidance to Product Development on new product/benefit cost impacts.
• You will develop and maintain pricing tools that price standard and custom benefits.
• The Actuary, Pricing will report to the Associate Director, Actuarial Pricing.
• The Actuary, Pricing establishes market level financial metrics to align with segment profitability goals, analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics.
• You will leverage market level projections and experience data tools to research root cause and capture insights.
• You will research and understand competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth.
• You will be accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations.
• You will advise executives to develop functional strategies (often segment specific) on matters of significance.

Actuary, Part D Pricing

Chief of Staff

• Analyze data and provide support for Board, Executive Leadership Team (ELT), Technology Leadership Team (TLT), and other executive-facing materials
• Maintain and report on Tech Scorecard tracking and cadence
• Prepare executive-level presentations that highlight data-driven challenges, opportunities, and strategic roadmaps
• Support Tech Quarterly Business Reviews (QBRs) and ensure alignment to CIO expectations
• Ensure all storytelling and materials reflect CIO priorities and executive alignment
• Conduct “red team” analysis for strategic bets and initiatives
• Assist with annual planning and CIO-driven, cross-tech, or enterprise ventures

Technology Advancement Professional – Tech Chief of Staff

Vice President

• Develop and execute the strategy and operating approach for the enterprise service simplification offering.
• Build and maintain a prioritized portfolio of automation and simplification opportunities, presenting recommendations to the Executive Leadership Team based on cost savings and business value.
• Govern large-scale, enterprise systems that support process analysis, automation, and service delivery to maximize value for Humana.
• Partner cross-functionally to identify and advance additional technology-enabled simplification opportunities.
• Ensure automation solutions meet the highest standards of accuracy, reliability, and security, recognizing that failures could result in significant business impact.
• Lead efforts to automate a significant percentage of business processes annually, delivering both headcount efficiencies and increased capacity for higher-value work.
• Establish and build a new team capable of operating seamlessly from inception, while collaborating closely with technology, information security, and business partners to protect proprietary data.
• Operate independently with minimal supervision while maintaining strong alignment with business stakeholders and senior leadership.

Associate Vice President – Service Simplification

Bilingual

• Support Pharmacists and patients by accomplishing programs developed to improve overall health outcomes
• Assist members by connecting them with financial assistance resources
• Make outbound and take inbound calls
• Collect medication history information
• Prepare members for comprehensive medication reviews

Bilingual Clinical Pharmacy Tech

Solutions Engineer

• Implementing cloud solutions across Humana’s IT infrastructure, including integration, maintenance, and support.
• Analyzing complex issues and determining the best technical approach for project components, often with considerable independence.
• Collaborating with stakeholders to evaluate and enhance cloud systems, ensuring optimal performance and scalability.
• Leading rollouts of cloud management platforms and driving continuous improvement through performance evaluations and enhancements.

Senior Cloud Solutions Engineer – Genesys IVR

Full-stack Engineer

• Design, develop, test, and maintain production-grade applications using Node.js, JavaScript, and TypeScript
• Build responsive and maintainable user interfaces using Vue.js or similar modern frameworks
• Design, develop, and consume RESTful APIs and GraphQL APIs to support scalable and loosely coupled systems
• Build and integrate cloud-native solutions on Microsoft Azure, leveraging appropriate platform and application services
• Design and implement event-driven and distributed systems, including Kafka-based messaging and streaming solutions
• Contribute to architectural decisions, evaluating technical trade-offs to ensure scalability, performance, security, and maintainability
• Ensure solutions align with enterprise architecture standards while remaining delivery-focused and pragmatic
• Troubleshoot and resolve complex technical issues across application and infrastructure layers
• Provide technical leadership through code reviews, design discussions, and mentorship of less-experienced engineers
• Collaborate effectively with cross-functional teams and communicate complex technical concepts clearly to both technical and non-technical stakeholders
• Influence departmental technical direction and contribute to continuous improvement initiatives

Senior Software Engineer

Analyst

• Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.)
• Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.)
• Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.)
• Supporting implementation of Medicare pricer projects and enhancements
• Reviewing pricing software vendor specifications
• Identifying system changes needed to accommodate CMS logic
• Assisting with requirements development
• Creating and executing comprehensive test plans
• Ongoing Medicare Pricer maintenance, quality assurance, and compliance
• Determining root causes driving issues and developing solutions
• Working closely with IT and pricing software vendor to resolve issues
• Utilizing data and expertise to identify automation and improvement opportunities
• Researching and resolving complex provider reimbursement inquiries and advise operational teams on Pricer edit resolution
• Providing consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic

Senior Provider Hospital Reimbursement Analyst

Manager

• Assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness state
• Guide members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
• Manage a caseload and completing assessments with members in their home or community‑based setting, as well as telephonically
• Provides clinical support and guidance, particularly for members with medical complexity
• Develop and coordinate care plans, ensuring that members receive appropriate services to manage their health needs effectively
• Address barriers to care and advocate for optimal member outcomes
• Review, assess, and complete medical complexity attestations and clinical oversight activities
• Ensure members receive services in the least restrictive setting to achieve and/or maintain optimal well‑being by assessing their care needs
• Develop and modify the Individual Care Plan and involve applicable members of the care team in the care‑planning process
• Support members and/or caregivers using an interdisciplinary approach to access social, housing, educational, and other services
• Serve as the primary point of contact for the Interdisciplinary Care Team (ICT) and coordinate with the member, ICT participants, and external resources to ensure the member’s needs are met

RN Field Care Manager

Pharmacist

• The Intern - Unpaid performs duties in field of study or profession
• Performs varied activities and moderately complex administrative/operational/customer support assignments
• Performs computations
• Typically works on semi-routine assignments
• Acts as an apprentice while completing formal education or immediately following graduation
• Decisions are typically focused on interpretation of area/department policy and methods for completing assignments
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Pharmacy Intern

Medical Director

• uses their medical background, experience, and judgement to determine whether requested services, level of care, or site of service should be authorized
• learns Medicaid requirements and operationalizes this knowledge in daily work
• conducts computer-based review of moderately complex to complex clinical scenarios
• reviews all submitted clinical records, prioritizes daily work, communicates decisions to internal associates
• participates in care management, with clinical scenarios arising from outpatient or inpatient environments
• conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations
• may require conflict resolution skills
• may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities
• supports Humana values and our enterprise social needs team mission throughout all activities
• flows to work as needed within cluster for vacations, weekends, and holiday coverage

Physical Health Medical Director

• Design, develop, test, and support scalable software applications and services
• Lead and standardize quality assurance and testing practices
• Oversee debugging efforts and implement effective, long-term fixes
• Investigate and resolve complex production and software issues
• Make technical decisions regarding architecture, tools, and implementation strategies
• Provide strong technical leadership and mentorship to engineers across the team
• Collaborate with cross-functional partners to deliver high-quality, consumer-focused solutions
• Contribute to engineering strategy and continuous improvement initiatives

Security Engineer

• Design and deliver innovative training programs shaping the cybersecurity culture at Humana
• Collaborate with leaders and subject matter experts to develop education ensuring workforce is equipped to navigate cyber risks
• Drive curriculum development for new products/tools and create technical resources
• Champion cyber awareness across all levels of the organization and reduce risk through human-focused, data-driven initiatives
• Work with stakeholders to develop, plan, coordinate, and evaluate cybersecurity training/education courses, methods, and techniques
• Produce technical documentation, presentations, and documents reinforcing cybersecurity knowledge across Humana
• Conduct learning needs assessments and identify requirements and plans instructional opportunities
• Support training of new tools and applications for cyber-awareness and proper usage.

Lead, CyberSecurity Advocacy

Product Manager

• Acts as the Agile team’s primary contact for work prioritization, decision-making, and product direction
• Collaborates with stakeholders to define and refine product requirements and priorities
• Facilitates Agile ceremonies including backlog refinement, sprint planning, and PI planning
• Monitors product performance and addresses production environment issues
• Communicates timely updates and insights to functional leaders
• Identifies product gaps and opportunities for improvement
• Begins to influence departmental strategy through product insights
• Makes decisions on product direction—not technical implementation

Senior Product Owner

• Evaluates member's needs and requirements to achieve and/or maintain optimal wellness state
• Guides members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members
• Meet members in their location and assess their needs and barriers
• Connect members with quality services to promote well-being and drive health outcomes
• Coordinates services, and monitoring and evaluating the case management plan against the member's personal goals
• Participates in facilitating interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care
• Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long Term Care Facilities and other care settings – 75-90% local travel

Insurance Product Compliance Lead

Actuary, Part D Pricing

Technology Advancement Professional – Tech Chief of Staff

Associate Vice President – Service Simplification

Bilingual Clinical Pharmacy Tech

Senior Cloud Solutions Engineer – Genesys IVR

Senior Software Engineer

Senior Provider Hospital Reimbursement Analyst

RN Field Care Manager

Pharmacy Intern

Physical Health Medical Director

Senior Software Engineer

Lead, CyberSecurity Advocacy

Senior Product Owner

Field Care Coordinator – Bilingual Preferred