Humana

Actuary

• Analyze financial, economic, and market data to support forecasting and business decisions
• Develop and maintain metrics, reporting, and analytical models to support business intelligence
• Evaluate industry, economic, financial, and competitive trends affecting organizational performance
• Build, enhance, and support actuarial and forecasting models used in financial analysis
• Work primarily in Databricks to develop Net Present Valuation models for Medicare Supplement, Dental & Vision, and Medicaid
• Ensure data integrity by establishing and executing processes and controls around data flow and quality
• Investigate data anomalies, perform root cause analysis, and implement practical, cost-effective solutions
• Collaborate with cross-functional partners to understand business needs, resolve model issues, and improve outcomes
• Identify opportunities to improve model performance, accuracy, and efficiency
• Independently manage moderately complex to complex assignments and determine appropriate technical approaches
• Contribute analytical insight that helps influence departmental strategy and forecasting practices
• Report directly to the Actuary, Analytics/Forecasting

Associate Actuary, Analytics, Forecast

Administrative Assistant

• Contribute to administration of utilization management
• Perform varied, moderately complex administrative, operational, and customer support assignments
• Perform computations
• Provide non-clinical support for policies and procedures ensuring appropriate treatment, care, or services for members
• Interpret department policies and methods for completing assignments
• Identify work expectations and quality standards within defined parameters
• Prioritize and schedule assignments with minimal direction
• Follow standard policies and practices while exercising independent discretion
• Complete a six-week training process
• Occasionally travel to Humana offices for training or meetings

Administrative Coordinator

General

• Support coordination, documentation, and communication of medical services and benefit administration determinations
• Interpret criteria, policies, and procedures to determine appropriate treatment, care, or services for members
• Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
• Follow established guidelines and procedures
• Report to the Behavioral Health Manager and participate in the Behavioral Health UM Team
• Work Monday through Friday during scheduled hours, with weekend and on-call rotations and potential overtime
• Complete a six-week training process
• Occasionally travel to Humana offices for training or meetings

Utilization Management Behavioral Health Professional

Nurse

• Assess members' health and safety needs to develop comprehensive Member Care Plans
• Conduct regular health assessments
• Coordinate with acute and primary care providers
• Educate members on disease processes, risks, nutrition, exercise, and lifestyle modifications
• Document in member files within required DHS contract timeframes
• Participate in monthly member phone contacts
• Travel to members' settings for in-person visits
• Support members enrolled in the Wisconsin Family Care Program through care coordination, support, and education
• Work remotely from home and travel approximately 40% to visit members

Registered Nurse – Care Manager

Full-stack Engineer

• Shape the product roadmap and challenge what should be built
• Turn rough problems into defined work, write stories, and sharpen requirements
• Own outcomes such as adoption, accessibility, performance, and reliability
• Run discovery, spikes, and prototypes before full implementation
• Engage directly with users and stakeholders when access permits
• Design, develop, and deploy full-stack applications end to end
• Build responsive WCAG 2.2-compliant user interfaces
• Implement accessible semantic HTML, ARIA, keyboard navigation, and screen-reader testing
• Optimize application performance and implement security best practices
• Apply test-driven development across unit, integration, and end-to-end tests
• Architect and implement scalable domain-driven Node.js microservices
• Design and develop efficient GraphQL services
• Deploy and manage applications on Azure, GCP, or AWS
• Use Docker or Kubernetes for scalability and resilience
• Build and maintain AI-accelerated development skills and tooling
• Partner with designers, product managers, and engineers in Agile teams
• Maintain technical documentation for APIs, microservices, and front-end components

Senior Product Engineer

Paralegal

• Perform law-related tasks including legal research and drafting legal documents
• Support the Pharmacy and PBM Legal Sub-team in managing commercial contract work
• Interpret varied work assignments and independently determine appropriate courses of action
• Apply department, segment, and organizational strategy and operating objectives to assigned work
• Make decisions regarding work methods, including in occasionally ambiguous situations
• Work with minimal direction and receive guidance where needed
• Review and analyze commercial agreements, amendments, non-disclosure agreements, and related documents under attorney supervision
• Occasionally travel to Humana offices for training or meetings

General Counsel

• Provide a full range of legal advice and services
• Manage internal and government investigations on behalf of the company
• Proactively identify opportunities to mitigate risk
• Manage complex litigation matters
• Collaborate with internal clients and outside counsel on litigation and case strategy
• Exercise independent judgment and decision-making on investigation and litigation issues
• Take full ownership of legal matters with modest to minimal supervision
• Perform sophisticated legal analysis
• Clearly communicate with business partners and other stakeholders

Counsel

• Assess members’ health and safety needs to develop comprehensive Member Care Plans
• Conduct regular health assessments
• Coordinate with acute and primary care providers
• Educate members on disease processes, risks, nutrition, exercise, and lifestyle modifications
• Document in member files within required DHS contract timeframes
• Participate in monthly member phone contacts and travel for in-person member visits
• Work from home and travel approximately 40% to visit members
• Complete record reviews for reassigned members and identify needed remediation
• Complete documentation for evident remediation updates
• Inform newly assigned RNs and Care Coach partners of missed or needed follow-up
• Assign tasks in the D365 system as needed
• Provide support for record review and remediation
• Support the team through process changes
• Accept additional complex member assignments
• Provide additional support with new member assignments
• Inform Managers of significant risks or concerns identified during record reviews

Registered Nurse Care Manager

Manager

• Assess members’ health and safety needs to develop comprehensive Member Care Plans
• Conduct regular health assessments
• Coordinate with acute and primary care providers
• Educate members on disease processes, risks, nutrition, exercise, and lifestyle modifications
• Document in member files within required DHS contract timeframes
• Participate in monthly member phone contacts and travel to in-person visits
• Complete record reviews for reassigned members and identify remediation needs
• Support record review and remediation activities
• Complete remediation documentation
• Inform newly assigned RNs and Care Coach partners of missing or needed follow-up
• Assign tasks in the D365 system
• Accept additional complex member assignments
• Support new member assignments
• Travel approximately 40% of the time to visit members
• Provide care coordination, support, and education to Wisconsin Family Care Program members

RN Care Manager

• Manage and oversee actuaries and/or support staff involved in identifying and managing risks
• Identify and analyze potential risks and estimate potential financial consequences
• Develop and recommend controls and cost-effective approaches to minimize risks
• Assess risks, opportunities, and mitigation strategies for compliant Medicare Advantage and Prescription Drug Plan bids
• Ensure compliance with CMS requirements related to Total Beneficiary Cost
• Maintain Humana's internal version of the CMS Out-of-Pocket Cost Model
• Obtain required inputs from business partners
• Run and interpret the Out-of-Pocket Cost Model results
• Partner with pricing actuaries to resolve test failures
• Support MA-PD and PDP bid filings through interpretation and implementation of CMS guidance
• Implement and execute review standards and controls to minimize bid-filing compliance risk
• Participate in CMS audits and reviews related to Medicare bids
• Create and maintain bid-filing process improvements
• Assess and communicate actuarial and business risks across the organization
• Provide peer review and counsel on company, industry, and regulatory practices
• Monitor developments in actuarial techniques
• Research laws and regulations applicable to actuarial science and insurance operations
• Advise executives on significant functional strategies
• Potentially lead one direct report

Actuary, Risk and Compliance

• Serve members in the Wisconsin Family Care program as part of the Inclusa/Humana team
• Provide comprehensive case management services to frail elders and adults with intellectual, developmental, or physical disabilities
• Assess members' health and safety needs, strengths, interests, and preferences to develop Member Care Plans
• Coordinate with a Field Care Nurse to address members' health and safety needs in the least restrictive environment
• Conduct face-to-face social assessments upon enrollment and at least every six months, typically at members' residences
• Conduct quarterly in-person visits and maintain monthly phone contact
• Arrange support services related to social integration, community resources, employment, housing, and other non-medical needs
• Ensure cost-effective service delivery
• Evaluate risk factors and provide education to members
• Maintain case notes, service authorizations, and Member Care Plan updates
• Travel within primarily Juneau County and surrounding areas

Case Manager

• Assess members' health and safety needs to develop comprehensive Member Care Plans
• Conduct regular health assessments
• Coordinate with acute and primary care providers
• Educate members on disease processes, risks, nutrition, exercise, and lifestyle modifications
• Document in member files within required DHS contract timeframes
• Participate in monthly member phone contacts
• Travel to members' settings for in-person visits
• Complete record reviews for reassigned members and identify remediation needs
• Support record review and remediation activities
• Complete remediation documentation
• Inform newly assigned RNs and Care Coach partners of missing or needed follow-up
• Assign tasks in the D365 system
• Accept additional complex member assignments
• Provide additional support with new member assignments
• Travel approximately 40% of the time to visit members

• Triage new recovery referrals and evaluate legal merit, damages, collectability, and cost-benefit viability
• Independently manage recovery matters from evaluation through resolution
• Handle demands, negotiation, litigation, arbitration, and settlement
• Manage recovery matters including subrogation, mass tort claims filings, product recall recoveries, restitution, small provider and pharmacy recoveries, breach of contract, and fraud recoveries
• Manage outside counsel on strategy, work product review, budgets, and performance
• Partner with business leaders, law colleagues, investigators, and others to identify recovery-eligible matters
• Communicate case status, strategy, and outcomes to internal stakeholders
• Occasionally travel to Humana offices for training or meetings

Counsel – Affirmative Litigation

• Assess members' health and safety needs to identify strengths, interests, and preferences and develop a comprehensive Member Care Plan
• Coordinate with a Field Care Nurse to provide services addressing members' health and safety needs
• Provide support in the least restrictive environment in accordance with the Member Care Plan
• Conduct face-to-face social assessments upon enrollment and at least every six months, typically at members' residences
• Conduct quarterly in-person visits and maintain monthly phone contact with members
• Arrange support services related to social integration, community resources, employment, housing, and other non-medical needs
• Ensure cost-effective service delivery
• Evaluate risk factors and provide education to members
• Maintain accurate case notes, service authorizations, and Member Care Plan updates
• Serve members across Green Lake, Marquette, Adams, and Waushara Counties
• Travel up to 40%

• Assess members' health and safety needs and develop comprehensive Member Care Plans
• Coordinate with a Field Care Nurse to address members' needs and provide support in the least restrictive environment
• Conduct face-to-face social assessments upon enrollment and at least every six months, typically at members' residences
• Conduct quarterly in-person visits and maintain monthly phone contact
• Arrange support services related to social integration, community resources, employment, housing, and other non-medical needs
• Ensure cost-effective service delivery
• Evaluate risk factors and educate members
• Maintain accurate case notes, service authorizations, and Member Care Plan updates