Jobs at Humana

The Decision Intelligence Engineer will design and improve reinforcement learning policies for Humana's Next Best Action platform, focusing on decision-making algorithms, simulation environments, and training pipelines, while ensuring outputs align with clinical eligibility rules.

The Utilization Management Clinical Pharmacist 2 reviews medication authorizations, advises on cost-effective utilization, and ensures quality patient outcomes by analyzing care plans and usage patterns.

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 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.

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.

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.

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.

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.

Lead design and operation of study designs and measurement strategies for CAHPS & HOS interventions. Build and scale lightweight A/B testing frameworks, manage a centralized learning inventory, partner with operations and vendors, evaluate causal impact, and iterate measurement to accelerate feedback and inform stakeholder decisions.

Lead sourcing and category management for pharmaceutical and other supply categories. Develop multi-year sourcing pipelines, supplier segmentation, risk-adjusted savings forecasts, negotiate with vendors, ensure compliance, and partner with leadership and cross-functional teams to implement sourcing programs and supplier sustainability and compliance initiatives.

Lead operational risk activities across business, Enterprise Risk, Regulatory Compliance, and Internal Audit. Conduct risk assessments, identify gaps/root causes, drive remediation, improve controls and processes, deliver data-driven reporting and visualizations, influence stakeholders, mentor teams, and support enterprise risk frameworks to improve compliance, efficiency, and member/provider experience.

Lead category strategy and sourcing for claims recovery and medical records procurement: develop sourcing plans, run supplier analysis and segmentation, negotiate and implement contracts, drive supplier relationships, ensure compliance, collaborate with internal stakeholders, and deliver multi-year savings and value.

Lead acquisition, cleaning, validation, storage and protection of datasets to support reporting and analysis. Design and execute data architectures, policies and ETL pipelines (SSIS, ADF) using cloud platforms (Azure Synapse, Snowflake, Databricks). Deliver dimensional models, visualizations, and lifecycle governance to make complex data accessible and drive business insights.

The Director oversees and develops state-level pharmacy policy, driving advocacy efforts and cross-functional collaboration to influence legislative outcomes and support Humana's business objectives.

Analyze and forecast financial, economic, and market data to support strategic and operational decisions. Develop premium variance reports, set monthly revenue targets, perform A:E analyses, expand explanatory driver interfaces, ensure data integrity and controls, troubleshoot anomalies, and collaborate with actuarial and finance partners.

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.

Configure and optimize Workday Payroll, Absence, and Time-Tracking workstreams; partner with Payroll, Benefits, and tech teams to define requirements, support integrations, provide tier-3 support, and improve the associate experience through business-process configuration and system stabilization.

Perform actuarial analysis and forecasting of financial, economic, and market data for Medicare Advantage underwriting margins. Own assumptions, perform reasonableness checks, troubleshoot data with suppliers, enhance claims/premium forecasting methodology, present monthly results to stakeholders, and extend models to additional lines of business.

Lead enterprise cash reconciliation and cash operations, oversee a team managing balance sheet reconciliations, drive automation and process improvements, ensure controls and audit readiness, build reporting/ dashboards, partner cross-functionally (AP, Billing, Claims, Treasury, IT), and manage unclaimed property and ASO customer reporting.