Humana

Operations

• Establish and maintain effective professional relationships with key upstream and downstream partners
• Management of program documentation, workgroups, and supporting infrastructure
• Coordinate across lanes to understand, advise, and influence future product development and operational expansion
• Develop deeper market relationships to translate market-specific needs into operational processes, controls, and evolution of technological solutions and reporting
• Support exploration, development, and piloting of HEDIS vendor capabilities to enhance operational processes across the two seasons; includes RFP and ongoing vendor evaluation as vendor capabilities advance and expand
• Facilitate initiatives to broaden data collection and enhance manual clinical review processes amidst technological and technical specification changes
• Provide leadership and guidance on continuous improvement efforts with enterprise partners to ensure HEDIS operational needs are accounted for, drive best practice standards, and facilitate communication and sign-off from stakeholders

HEDIS Non-Standard Supplemental Operations Lead

AI Engineer

• Serve as the senior technical leader for platform engineering, AI enablement, and enterprise software delivery initiatives.
• Drive strategy and architecture for AI developer tools and products, playing a key role in advancing Humana’s technology ecosystem with generative AI, automation, and intelligent agents.
• Lead platform engineering efforts to enable advanced AI developer tools and capabilities for Humana’s enterprise engineering teams.
• Architect and drive end-to-end solutions that integrate AI, automation, and intelligent agents to support software delivery and productivity.
• Collaborate with cross-functional partners including Leadership, Engineers, Product Owners, and business stakeholders to mature use cases, define technical requirements, and deliver impactful solutions.
• Provide technical strategy, oversight, and guidance for Enterprise AI Chatbot product development.
• Educate and enable teams across Humana on emerging AI technologies, best practices, and architectural patterns.
• Ensure operational excellence in code quality, artifact management, and security for AI platforms and tools.

Principal AI Engineer – Enablement

Platform Engineer

• Design and implement highly scalable platform services and shared infrastructure components that support both healthcare applications and advanced AI systems, ensuring these foundational services can handle growing data volumes, increased user loads, and evolving business requirements while maintaining consistent performance and availability across all environments.
• Develop and maintain comprehensive CI/CD pipelines that enable secure, automated, and compliant software delivery processes, incorporating automated testing, security scanning, compliance validation, and deployment orchestration to accelerate development velocity while maintaining rigorous quality and security standards required in healthcare environments.
• Build and operate containerized services using industry-standard technologies such as Docker and Kubernetes, ensuring resilience through proper health checking, auto-scaling, and graceful degradation patterns, while maintaining high availability through multi-zone deployments, circuit breakers, and comprehensive disaster recovery capabilities.
• Implement sophisticated observability solutions including comprehensive monitoring, centralized logging, detailed metrics collection, and distributed tracing capabilities to support operational excellence, enable rapid troubleshooting, facilitate capacity planning, and provide deep insights into system behavior across complex microservices architectures.
• Design and maintain robust storage solutions and efficient data models across both relational databases (e.g., PostgreSQL, MySQL) and non-relational systems (e.g., MongoDB, Redis, Cassandra), ensuring data integrity, optimal query performance, proper indexing strategies, and adherence to data governance requirements specific to healthcare data handling.
• Perform thorough production troubleshooting and comprehensive root cause analysis to identify and resolve system issues, implementing preventive measures to strengthen platform reliability, reduce mean time to recovery (MTTR), and continuously improve system stability through post-incident reviews and actionable remediation plans.
• Collaborate effectively with product engineering teams, security specialists, and compliance officers to translate complex business requirements into reusable, well-documented, and secure platform capabilities that can be leveraged across multiple teams and projects, promoting consistency and reducing duplicated effort
• Document technical tradeoffs, architectural decisions, and implementation patterns clearly and concisely using architecture decision records (ADRs), design documents, and comprehensive runbooks that enable knowledge transfer, facilitate onboarding of new team members, and support long-term system maintainability.
• Support comprehensive compliance, security, and governance requirements including healthcare regulatory considerations such as HIPAA privacy and security rules, ensuring all platform systems implement appropriate access controls, encryption at rest and in transit, audit logging, and data retention policies.

Senior AI Platform Engineer

• Lead the comprehensive architecture and detailed design of enterprise platform services
• Define and implement best practices for infrastructure as code and CI/CD automation
• Drive complex platform modernization initiatives including dependency upgrades across large service ecosystems
• Establish and enforce reliability, resiliency, and observability standards
• Partner strategically with product teams and security architects
• Author comprehensive design documents and lead thorough architectural reviews
• Mentor engineers through code reviews and technical discussions
• Ensure adherence to security best practices and healthcare compliance requirements

Lead, AI Platform Engineer

Director

• Orchestrate the activation of CenterWell's owned channels—social, email/automation, SMS, portal, and reputation management.
• Translate strategic priorities from the Line of Business Digital Activation team into actionable channel plans, workflows, and continuous optimization programs.
• Lead integrated channel activation, translating LOB digital strategies into coordinated communication plans across various channels.
• Build and manage unified activation workflows, ensuring efficient processes for intake, prioritization, testing, and delivery.
• Drive channel optimization, establishing goals, KPIs, testing programs, and continuous improvement frameworks.
• Oversee campaign execution, including segmentation, targeting, timing, and performance enhancement.
• Partner with cross-functional teams to ensure communications are accurate and strategically aligned.
• Use insights to improve channel efficiency and streamline processes.

Associate Director, Channel Activation & Optimization

Vice President

• The Regional VP will be accountable for Hospital and Ancillary strategic relationships for all product lines in the state of Florida.
• This position will develop networks that help advance Humana's strategy and goals toward improving the health of the communities we serve.
• This position will also work with potential joint ventures and other innovative partnership opportunities as well as develop and lead contracting efforts and strategies for continuous unit cost improvement.
• The RVP of Contracting will represent Humana as a member of the regional executive team and report directly to the Regional President of Florida.
• Ensure adequate coverage of hospital, specialty and ancillary services for Humana to meet both regulatory and strategic needs.
• Partner with facilities and ancillary lines of business to achieve shared success.

RVP Contracting – Hospital/Facility and Ancillary Services

Architect

• lead the strategic evolution of the GRC capabilities
• shaping architecture decisions
• driving transition toward Archer’s NRGX platform
• influencing how risk, cybersecurity, and compliance operate across the organization
• technical planning, architecture development and modification of specifications
• develops specifications for new products/services, applications and service offerings
• advises executives to develop functional strategies on matters of significance
• leading the design, architecture, and strategic evolution of the RSA Archer IRM platform
• partner with business stakeholders, risk leaders, and technology teams to deliver scalable, secure, and high-performing Archer solutions

Lead Application Architect

• monitors and measures relevant performance metrics to assess the performance of IT resources
• optimizes performance through process improvement activities
• devises measures and targets to assess and optimize the performance of IT functions, services, projects and any related improvement initiative
• identifies and analyzes performance measures and metrics
• develops and maintains balanced scorecards and dashboards
• begins to influence department’s strategy
• makes decisions on moderately complex to complex issues regarding technical approach for project components
• establishes policy and optimizes processes by leveraging industry practices to lean processes and reduce waste
• recommends improvements and enhancements to the existing process framework and supporting capabilities

Senior IT Business Performance – Process Improvement Professional

Manager

• Report to the Associate Director of Care Management
• Use clinical nursing skills to support coordination, documentation, and communication of medical services and benefit administration determinations
• Operate within established guidelines and use advanced technical expertise to address moderately complex issues
• Determine methods, resources, schedules, and goals based on assigned goals
• Responsible for leadership and oversight of the physical health Utilization Management staff in daily operations
• Hire, coach, counsel and evaluate performance of direct reports
• Implement and maintain processes compliant with MDHHS and NCQA guidelines
• Work with UM leadership to reduce inefficiencies and provide solutions to improve clinical outcomes
• Collect and analyze data to guide operational metrics and associate performance
• Coordinate and communicate with Providers, Members, or other parties to facilitate care and treatment
• Facilitate cross-departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across departments.

LTSS UM Nurse Manager

Engineer

• perform identity and access management tasks related to end user access, such as access additions, modifications, deletions and disables from various systems
• validate roles and entitlements within the IT systems
• identify role entitlement inconsistencies and provide resolution
• conduct user recertification reviews, as defined by company policies
• understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• follow established guidelines/procedures

Identity and Access Management Engineer

Product Manager

• Responsible for contributing to a product area within our applied AI portfolio, defining success metrics, prioritizing problems, and identifying the best AI-driven strategies aligned with business goals.
• Work directly with business stakeholders to understand their operations, capture requirements, map processes, and identify high-impact opportunities for AI.
• Translate business problems into clearly scoped AI use cases and drive them from concept through prototyping to validation.
• Contribute to rapid prototyping of AI solutions, including GenAI applications, AI agents, conversational AI, and intelligent automation, to demonstrate feasibility and business value.
• Work with a cross-functional team of engineers, designers, and data scientists to define products, develop roadmaps, and drive progress against goals and milestones.
• Gather and analyze user research, business process data, and market analysis to inform product decisions and influence the wider product organization.
• Contribute to evaluation frameworks to test, benchmark, and compare AI models and platforms against enterprise requirements.
• Contribute to reusable product frameworks, playbooks, and best practices that accelerate AI solution delivery across the organization.
• Communicate product strategy, progress, and business value with clarity to all stakeholders.
• Support experimentation, A/B testing, and iterative design approaches to continuously improve AI solutions.

Senior Product Manager, AI

Auditor

• Handle provider disputes in a result-oriented and metrics-driven environment
• Ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality
• Consult and collaborate with coding professionals within and across departments
• Make coding decisions based on standard industry guidelines and best practices
• Manage multiple priorities, collaborate with peers and ensure timely completion of outpatient coding disputes

DME/Outpatient Medical Coding Auditor

• Utilize high-quality, evidence-based behavioral health services through personalized care coordination, crisis intervention, peer support, and strong collaboration with medical and behavioral health providers.
• Provide comprehensive, integrated support to members experiencing behavioral health conditions, including children, adolescents, adults with serious mental illness (SMI) and serious emotional disturbance (SED), Substance Use Disorders (SUD) and justice-involved members.
• Engage members in their own communities, meeting them face-to-face whenever possible to build trust and facilitate meaningful care coordination.
• Coordinate behavioral health and medical services, ensuring appropriate provider engagement and adherence to treatment plans.
• Improve member's health literacy while simultaneously addressing health related social needs to positively impact member's healthcare outcomes and well-being.
• Serve as the driver of the member's interdisciplinary care team (ICT), overseeing care planning, transitions, and service delivery.
• Facilitate ICT meetings, ensuring communication among providers, Service Coordinators, and Care Management Extenders.
• Proactively support transition of care efforts.
• Will work with autonomy but reach out when support is needed.
• Collaborate with internal departments, providers, and community-based organizations to link to appropriate services and create a seamless, culturally competent care experience that respects the members' preferences and needs.
• Follow processes and procedures to ensure compliance with regulatory requirements by the Illinois Department of Human Services (IDHS), Center for Medicare and Medicaid Services (CMS) and the National Committee on Quality Assurance (NCQA).

Field Care Manager, Behavioral Health

Actuary

• Analyze and forecast financial, economic, and other data to provide accurate information for strategic and operational decisions
• Establish metrics, provide data analyses, and work directly to support business intelligence
• Evaluate industry, economic, financial, and market trends
• Ensure data integrity by developing and executing necessary processes and controls around data flow
• Collaborate with stakeholders to understand business needs/issues, troubleshoot problems, conduct root cause analysis
• Support the Primary Care business with a focus on IBNR (Incurred but not reported) and claims analytics

Associate Actuary – Primary Care

• Serves as a senior technical authority responsible for guiding Humana’s enterprise platform strategy and engineering execution
• Leads the design, development, and operation of foundational agentic AI platforms, tools, and services that empower development teams to build, deploy, and operate agent-driven applications efficiently, securely, and reliably
• Influences architectural direction for core infrastructure supporting agentic AI workloads
• Drives innovation in developer experience and automation—including agent orchestration and human-AI collaboration
• Mentors engineering teams, ensuring that platform solutions are robust, scalable, secure, and aligned with Humana’s enterprise agentic AI technology roadmap
• Evaluates, selects, and integrates foundational agentic AI technologies
• Builds and maintains robust CI/CD and agentic AI pipeline automation for automated testing, deployment, and release management
• Develops internal tools, APIs, and services that abstract agentic AI infrastructure complexity