Teams at Humana

Provide person-centered case management for Wisconsin Family Care members—assess health and safety, develop and update Member Care Plans, coordinate services with care nurses and community resources, perform face-to-face and monthly contacts, ensure cost-effective service delivery, evaluate risk, educate members, and maintain accurate documentation and service authorizations.

Lead product strategy and execution for AI-driven claims payment integrity solutions. Own vision, roadmap, and integration of anomaly detection, audit tools, and LLM feedback loops. Partner with business, operations, vendors, and engineering to deliver scalable prepay/postpay audit capabilities, drive ROI, establish KPIs, oversee releases, and represent the CPI ART in intake and change-management activities.

Analyze large healthcare datasets and develop complex SQL queries using Azure Synapse/Databricks. Build Power BI reports, produce monthly reconciliations and ad-hoc analyses in Excel/PowerPoint, support payments to value-based specialists, evaluate and expand value-based programs, automate processes with Power Automate/Power Apps, and communicate findings to senior leadership while spearheading new technologies.