Jobs at Humana

Provide executive-level administrative support to Medicaid senior leadership, managing complex calendars, travel, meetings, communications, and confidential materials. Coordinate events, prepare presentations and briefings, handle expense reporting, lead administrative programs, and proactively solve scheduling and operational issues.

Lead utilization management activities for Michigan DSNP members: oversee prior authorization reviews, ensure CMS/NCQA/MDHHS compliance, analyze UM data, develop quality metrics and interventions, coordinate with clinical leadership and state agencies, and support UM operations and reporting.

Support Medicare market and provider finance by building hospital unit cost models, performing actual-to-expected analyses, quantifying financial impacts of contracting and reimbursement changes, and producing executive reporting and Power BI dashboards. Partner with Network, Provider, Finance, and stakeholders using actuarial methods, claims data, and analytical tools (Excel, SQL Server, Databricks).

Perform quality assurance audits of medical records and ICD-9/10 diagnosis coding, ensure coding accuracy supported by clinical documentation, follow federal/state regulations and internal guidelines, retrieve medical records, support provider education on coding compliance, and provide administrative/customer support. Position is remote with occasional regional travel for training and record retrieval.

Builds and manages ETL processes and data pipelines in Azure Databricks using PySpark. Integrates data from multiple sources, tunes Spark and SQL for performance, troubleshoots pipeline failures, automates manual processes, and supports reporting and analytics to inform business decisions.

Lead an applied AI product area: define success metrics, translate business problems into AI use cases, prototype and validate GenAI and conversational solutions, collaborate with engineers/designers/data scientists, run experiments and A/B tests, and communicate product strategy and ROI to stakeholders.

Lead Product Designer responsible for driving user-centered mobile and web experiences across dashboards, navigation, search, and a shared design system. Partner with product, engineering, research, and content to translate insights into strategy, prototypes, and high-quality components. Lead workshops, evangelize design vision, ensure accessibility and standards, and guide teams through research, ideation, testing, and implementation within Agile delivery.

Design and deliver BI solutions by analyzing large, complex healthcare datasets. Architect MDM/identity-resolution and semantic models, untangle legacy data ecosystems, defend technical approaches to executives, influence strategy, and implement cloud/Databricks-based ETL and analytics solutions.

Provide clinical and coding expertise to optimize provider performance in Medicare Stars, Medicare Risk Adjustment (MRA), and Interoperability. Develop policies and educational materials, resolve coding escalations, train providers and market associates, and act as a clinical consultant across Quality and Cost Strategy to drive practice improvement.

Lead design, development, and optimization of Power BI dashboards and data models, analyze complex business problems using SQL and large datasets, deliver insights to executive leadership, maintain data accuracy and KPIs, drive BI process improvements and automation, and serve as the Power BI subject-matter expert across cross-functional teams.

Manage Wisconsin Medicaid BI reporting suite, develop analytics and cloud-based solutions, ensure data quality, analyze data and create visualizations to drive decisions, communicate insights to stakeholders, and travel quarterly for team meetings.

Review and adjudicate complex or specialty insurance claims (paper and electronic). Determine return, denial, or payment per policies. Perform computations, work with multiple computer systems, multitask, and provide administrative/customer support. Complete mandatory in-person training then transition to remote schedule with a 120-day appraisal and strict attendance requirements.

Handle inbound telephone, digital, and written customer inquiries about benefits and provider issues. Resolve and escalate complex questions, record interactions, follow policies, and work within defined quality standards while managing multiple applications.

Design, build, deploy, and maintain generative AI solutions for ITSM using Databricks and Azure. Collaborate with data engineering and business teams, extend APIs/SDKs, lead technical design, and support production ML systems.

Lead analytics projects using advanced and predictive modeling to optimize programs, forecast behavior, and drive revenue. Partner consultatively with business, IT, and SMEs across project lifecycle—intake through delivery—communicating results to stakeholders and senior leadership. Work independently on complex technical approaches and influence department strategy.

Provide clerical support for Adult Family Home certifications: data entry, document coding/filing, coordinating certification activities, responding to routine inquiries, compiling reports/statistics, and performing general administrative tasks (phone, copying, filing) following established procedures.

Sell Humana ancillary Group benefits (Dental, Vision, Life, Disability) to employers (50+ lives). Build and maintain broker/consultant relationships, deliver presentations, negotiate, cross-sell, track activity in CRM, support post-sale enrollment, and collaborate with internal teams to drive territory growth and retention.

Lead content design across web, mobile, and digital products using research, analytics, and audits. Create clear, accessible UI copy and multi-channel content, structure information for findability, partner with cross-functional teams including legal/compliance, contribute to content systems and guidelines, and optimize content through testing and measurement in a regulated healthcare environment.

Lead content design across web, mobile, apps, virtual assistants, and AI surfaces. Use research, analytics, and audits to inform strategy; build scalable content systems, taxonomies, and governance; craft clear, accessible content for regulated experiences; optimize via measurement and testing; and partner cross-functionally to deliver compliant, user-centered product experiences.

Lead medication therapy optimization and comprehensive medication reviews for members, provide Rx education and counseling via outbound calls, oversee clinical programs for multi‑drug patients, influence departmental strategy, and manage moderately complex clinical initiatives independently.