Jobs at Humana

Designs, tests, and deploys data protection and security solutions (focus on Privacera) across Azure and GCP. Builds CI/CD pipelines, performs risk assessments and proofs-of-concept, supports incident response, and drives security R&D and integrations into cloud environments. Collaborates with stakeholders and influences security strategy.

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.

The Software Engineer develops and implements applications, collaborates with stakeholders, follows software standards, and oversees quality assurance. Requires problem-solving skills to design and integrate systems.

Lead development and execution of channel strategies to improve Stars outcomes. Manage cross-functional, enterprise programs from planning through execution, drive governance, performance reporting, backlog prioritization, sales channel readiness, stakeholder alignment, and executive communications to deliver regulatory-compliant business results.

Retrieve, review, and validate medical records on-site; conduct QA audits of records and ICD-9/10 codes; upload verified documents to Cotiviti repository; maintain PHI confidentiality (HIPAA); manage high-volume outreach to provider offices and meet service-level expectations.

Lead the development of Next Best Action strategies using Adobe Journey Optimization, ensuring personalized customer engagement through data-driven decisioning and content orchestration.

Lead design and enablement of scalable, reusable customer journey blueprints using Adobe Journey Optimizer. Collaborate with marketing, data science, IT, and agile pods to embed personalization, NBA decisioning, and multivariant testing; provide templates, governance, and documentation to accelerate pod execution and ensure compliant, measurable, enterprise-scale journeys.

Provide high-level administrative and operational support to senior leaders: manage complex calendars, communications, meetings, travel, document preparation, and office operations; optimize workflows and use Microsoft 365 and AI productivity tools to improve efficiency and reporting.

Designs and develops BI solutions by analyzing large datasets, building and optimizing SQL queries, and creating data visualizations (Power BI/Tableau) to inform strategic decisions. Works independently on complex problems, influences departmental strategy, and supports healthcare-focused analytics.

Lead state advocacy and government engagement across CO, NM, and TX. Develop and execute political engagement plans; cultivate relationships with state officials and agencies; advance legislative, regulatory, and public sector priorities; manage consultants and trade associations; align advocacy with market growth; monitor state policy risks and opportunities; support procurement and provide timely policy insights to internal stakeholders.

Provide digital forensics and incident response expertise: collect and analyze forensic data, identify root cause, recommend remediation, manage real-time forensic capability, produce investigative reports for leadership, influence strategy, and participate in on-call rotation. Work involves complex cases across Humana infrastructure and occasional travel for training or meetings.

Manage claims operations including customer contact, investigation, approval and settlement of claims. Work with insurers, providers, members and collections to resolve pending claims, exercise judgment in prioritizing and interpreting processes, and perform advanced administrative and operational support. Remote role with required virtual training and availability for weekday shifts in EST.

Analyze, integrate, and visualize complex datasets using SQL, Snowflake, Azure and BI tools. Develop long-term data solutions, elicit and document requirements, write Agile user stories, coordinate cross-team work, ensure data quality, support incidents and implement change management.

Provide high-level executive support to three senior leaders: manage calendars, coordinate complex travel and meetings, prepare presentations and materials, complete expense reconciliation, triage communications, and anticipate needs. Maintain confidentiality and professionalism while balancing multiple priorities in a fast-paced corporate environment.

Review and determine medical necessity and level of care for prior authorization requests, communicate with providers ( ~50% telephone), document clinical findings in medical management systems, educate providers on utilization processes, and refer complex cases to appropriate stakeholders following guidelines and policies.

Lead pharmacy compliance efforts for Medicare Parts B and D, interpret regulatory guidance, perform audits and risk assessments, support PBM and dispensing operations, coordinate regulator audits, and collaborate across business units to monitor and remediate compliance risks.

Design, develop, and maintain cloud-based big data solutions primarily on Microsoft Azure. Implement cloud strategy, plan integrations, build CI/CD pipelines, and collaborate with stakeholders, product managers, and engineers. Lead rollout and optimization of cloud management platforms, make technical decisions for complex issues, and ensure robust data processing and deployment practices.

Lead cloud implementation strategy primarily on Azure, design and maintain cloud architecture, enable scalable data platforms and analytics, collaborate with product teams, roll out cloud management platforms, mentor developers, and communicate solutions to stakeholders within an agile framework.

Lead AI-driven reconciliation and automation to improve encounter data quality. Own model performance, identify root causes, partner with technical and business teams to enhance models, prioritize roadmap, and scale automation while communicating results to stakeholders.

Design and deliver finance-focused BI solutions: build advanced Power BI reports, develop complex SQL queries, transform payer financial and claims data into standardized accounting formats, support specialty teams, manage vendor relationships for specialty care, analyze data to solve business problems, and communicate insights to stakeholders and leadership.