Humana

Medical Billing and Coding

• Review appropriate DRG and ICD-10-CM/PCS coding assignments for accuracy within the appeals team
• Consult and collaborate with coding professionals within and across departments on coding disputes
• Ensure accountability of coding dispute outcomes for timeliness, compliance, and quality
• Conduct inpatient coding audits involving MSDRG/APDRG
• Ensure accuracy and compliance of coding appeal reviews using applicable coding guidelines
• Communicate appeals outcomes to providers professionally and concisely
• Make coding decisions based on industry guidelines and best practices
• Manage multiple priorities and ensure timely completion of inpatient coding appeals
• Report to the Manager

Inpatient Medical Coding Auditor

Cloud Engineer

• Participate in the design and development of cloud-based solutions and applications in the big data space
• Implement Humana's cloud strategy from a technical perspective, including design, planning, integration, and maintenance
• Work with stakeholders across the organization to evaluate cloud systems and identify appropriate solutions
• Collaborate with product managers and engineers to develop specifications for cloud-based products, services, applications, and solutions
• Drive the rollout of cloud management platforms
• Evaluate cloud management platform performance and implement enhancements
• Make technical approach decisions for project components
• Influence the department's strategy

Senior Cloud Solutions Engineer

Product Manager

• Convey product vision and roadmap to an Agile delivery team
• Define user stories and prioritize the product backlog
• Maximize the value of products created by the Agile team
• Liaise with stakeholders and the development team to ensure the right product is built in the right order, within budget and by the deadline
• Serve as the Agile team's primary contact for information, work prioritization, and decision-making
• Influence department strategy
• Make decisions on technical approaches for project components
• Determine objectives and approaches to assignments with considerable latitude
• Report to the Director, Product Management
• Support Humana's efforts to secure and transition into a new business opportunity

Senior Product Owner

Community Health Worker

• Contribute to administration of care management
• Provide non-clinical support for member needs assessments and evaluations
• Guide members and families toward appropriate care and wellbeing resources
• Engage Medicaid enrollees through Humana's Comprehensive Care Support teams
• Address social determinants of health and support chronic-condition self-management
• Navigate healthcare systems and promote prevention and tailored health education
• Conduct in-person assessments of member care needs, preferences, socioeconomic barriers and home environments
• Assist with scheduling physical and behavioral health visits and address attendance barriers
• Advocate for members with providers, community resources, schools and other entities
• Coordinate access to housing, food, income and transportation resources
• Monitor care-plan adherence and provide motivational interviewing for medication and treatment adherence
• Provide culturally appropriate social support, health education and health coaching
• Attend community events to connect with members and educate them about case management services
• Conduct research and in-person outreach to locate difficult-to-contact members
• Assist with Health Risk Screenings and Welcome Calls
• Build relationships with providers and community resources and identify community resource gaps
• Support Humana's Readmission Prevention and ED Diversion program
• Collaborate with case managers, housing specialists, SDOH coordinators, ED Liaison and Redetermination Specialist
• Perform other duties as assigned

Director

• Direct, monitor, and support learning experience analysis, planning, design, and development
• Identify, analyze, and address complex business challenges through learning interventions
• Analyze contractual requirements and develop and implement an Annual Training Plan
• Consult on and design change management solutions to maximize learner capabilities and operational excellence
• Lead cross-functional efforts to ensure training interventions comply with federal contract obligations
• Lead a team of learning professionals conducting needs analysis and designing and developing learning experiences
• Use learning technology to implement performance improvement and professional development solutions
• Oversee consultation, design, and development processes using a customer-centric approach
• Analyze complex business problems using internal and external data
• Identify subject matter experts and produce learning solution recommendations and plans
• Conduct needs analysis to determine appropriate solutions
• Align learning interventions with corporate vision, Design Thinking, and Adult Learning Theory
• Identify KPIs and create measurement strategies to validate business impact
• Select, develop, and evaluate personnel
• Advise executives on functional learning strategies
• Track and analyze training program effectiveness
• Exercise independent judgment on complex issues and work under minimal supervision
• Support Humana’s efforts to secure and transition into a new business opportunity

Associate Director – Learning Design

Operations

• Assist with the stand-up and implementation of a new VA CCN Contract
• Establish the operational framework, processes, and controls necessary for contract execution
• Partner across multiple teams to identify process improvement opportunities
• Implement solutions that enhance performance across claims and financial services operations
• Monitor and oversee claims and financial inventory
• Implement workflow enhancements and operational controls
• Report to an Associate VP, Financial Planning and Analysis

Process Improvement Lead

Financial Planning and Analysis

• Lead the regional P&L and connect financial outcomes with operational effectiveness
• Collect, analyze and report market data
• Develop strategies to improve membership, medical expense, administrative and margin outcomes
• Provide leadership and direction to the regional Finance team
• Serve on the Regional Leadership team
• Collaborate with Provider Network, Health Services and Network Performance leaders on product, network, quality and operational strategy and execution
• Lead the annual Medicare Advantage/CMS product bid process
• Develop and provide fiscal and operational oversight of the regional annual budget
• Lead financial planning, projections, risk management, operational metrics and reporting
• Lead strategic discussions with physician and hospital leaders
• Lead finance associates analyzing financial drivers for value-based providers
• Interface with regional, divisional and corporate leaders
• Lead regional market-level strategy development with operational leaders
• Achieve margin and administrative budget targets
• Design and implement compliant policies and procedures
• Establish management and performance controls through data tracking, measurement and analysis
• Identify problems, prevent losses, contain costs and direct process improvements
• Maintain administrative budget oversight
• Provide strategic and financial analysis for provider contracting, performance, health services and trend identification
• Cultivate internal and external business relationships

Regional VP, Operations – Finance

• Drive the strategy, development, and optimization of Adobe Experience Platform for Adobe Web Integrations
• Translate business needs into platform capabilities enabling personalized, data-driven customer experiences
• Grow enterprise adoption and usage of Adobe Experience Platform
• Collaboratively own and manage the product backlog for H.com or myH platform capabilities
• Translate enterprise strategy, regulatory requirements, and business needs into product requirements, user stories, and acceptance criteria
• Partner with business, engineering, architecture, and delivery teams to plan, execute, and release platform enhancements
• Lead development of capabilities including consent capture, preference updates, suppression logic, policy enforcement, and downstream activation
• Drive integration with authenticated and unauthenticated web channels
• Ensure data models, APIs, and workflows meet enterprise standards and regulatory guidance
• Validate support for omnichannel use cases across web, mobile, CRM, contact center, and third-party integrations
• Identify dependencies, risks, and tradeoffs, escalating decisions as needed
• Partner with myH, H.com, Next Best Action, Marketing, Digital, CRM, Customer Service, Legal, Privacy, and Compliance teams
• Support platform onboarding and adoption through enablement, documentation, and partnership
• Collaborate with data, identity, and analytics teams on consent and preference data
• Serve as a day-to-day product escalation point
• Advocate for intuitive, transparent, customer-centric experiences
• Incorporate customer, compliance, and operational feedback into product iteration
• Track and report KPIs including consent capture rates, preference usage, data quality, error rates, and activation success
• Identify opportunities to reduce operational friction, manual processes, and compliance risk
• Monitor platform performance and integration health, driving corrective actions and enhancements

Lead Product Manager – Adobe, Web Integrations

Nurse

• Interpret and support the coordination, documentation, and communication of medical services and benefit administration determinations
• Use established medical criteria and information from attending physicians and other care providers to make determinations
• Complete request determinations within established processing time frames
• Communicate with providers, members, and other parties to facilitate care and treatment
• Help deliver coordinated care for members
• Support post-acute care services including Skilled Nursing Facility, Home Health, and Durable Medical Equipment
• Understand department, segment, and organizational strategy and operating goals
• Report to the Manager of Utilization Management as part of the One Home/Home Solutions Utilization Management team

Utilization Management Registered Nurse

Representative

• Handle 40+ inbound calls daily from providers in a back-to-back call center environment
• Address benefit questions, service issues, and general inquiries
• Escalate unresolved and pending customer grievances
• Document interactions, actions taken, and outcomes in internal systems
• Resolve routine to moderately complex issues using established guidelines and workflows
• Identify issues requiring escalation and hand off to appropriate teams
• Meet quality, productivity, and customer experience expectations
• Support members and providers by answering questions, resolving concerns, and guiding them through next steps
• Deliver empathetic, accountable, high-quality customer experiences
• Attend virtual training and required leadership meetings with camera on

Inbound Contacts Representative

Network Operations

• Manage provider data for health plans, including demographics, rates, and contract intent
• Manage provider audits, provider service and relations, credentialing, and contract management systems
• Execute processes for intake and management of provider-perceived service failures
• Set daily priorities for an administrative work group and/or external vendors
• Coordinate work activities and monitor progress toward schedules and goals
• Oversee the work of others and/or serve as the primary administrative owner of a main process, program, product, or technology
• Work within broad guidelines with little oversight

Network Operations Coordinator

Analyst

• Support successful value-based provider relationships
• Improve the provider experience and achieve path-to-value goals
• Interpret department, segment, and organizational strategy and operating objectives
• Analyze provider financial patterns and trends using Excel and/or SQL
• Update, maintain, and review fee scheduling and pricing structures
• Review provider contracts and ensure rates are priced and applied accurately
• Identify process recommendations and ensure compliance with government regulations
• Collaborate and communicate with internal partners across various departments
• Travel occasionally to Humana offices for training or meetings when required

Value-Based Programs Analyst

Network Engineer

• Design, analyze, plan, and modify network components supporting customer communication implementation activities
• Develop and evaluate network performance criteria and measurement methods
• Prepare analyses of short-term and long-term capacity needs for switching, routing, transmission, and signaling
• Conduct network architecture design, feasibility, and cost studies
• Develop alternative routing scenarios and changes in the required sequence of network activities
• Conduct economic and population growth studies to assess impact on network capacity and development plan projections
• Identify and resolve complex technical and operational problems within departments
• Potentially lead multiple managers or highly specialized professional associates

Associate Director – Network Engineering

Procurement

• Generate and implement efficient sourcing and category management strategies
• Manage the company's supply portfolio and ensure spending transparency
• Comply with federal and state regulatory guidelines
• Reconcile purchases with vendor invoices
• Validate pricing and contract compliance
• Monitor sales and margins through vendor negotiations and promotional opportunities
• Manage purchasing activities with pharmaceutical companies for drug purchasing
• Influence department strategy
• Make decisions on technical approaches for project components
• Report to an Associate Director
• Work as an individual contributor
• No domestic travel; occasional travel to Humana offices for training or meetings may be required

Senior Procurement Professional

• Lead project-level answer generation and ensure alignment with enterprise transformation goals
• Oversee day-to-day execution of projects with staffed delivery resources, typically two teams of 1–3 members each
• Identify and raise cross-functional connections and dependencies for Transformation Office engagement
• Build and maintain relationships with key business stakeholders
• Develop project workplans and define delivery approaches
• Provide input on project scope
• Coach and develop Leads, Consultants, and Analysts
• Foster team growth and capability building
• Oversee multiple project teams and manage dependencies
• Provide thought leadership to shape approaches aligned with broader transformation objectives