Company Detail

Job Description

Become a part of our caring community and help us put health first

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This position provides the opportunity to lead/manage large cross-functional enterprise projects that impact our members, providers, vendors, and internal stakeholders.

Responsibilities Include:

• Designing, communicating, and implementing an operational plan for completing the project; monitoring progress and performance against the project plan; taking action to resolve operational problems and minimize delays

• Identifying, developing, and gathering the resources to complete the project

• Preparing designs and work specifications; developing project schedules, budgets, and forecasts; and selecting materials, equipment, project staff, and external contractors

• Communicating with other operational areas in the organization to secure specialized resources and contributions for the project

• Conducting meetings and preparing reports to communicate the status of the project.

• Setting priorities, allocating tasks, and coordinating project staff to meet project targets and milestones

• Advising executives to develop functional strategies (often segment specific) on matters of significance

Use your skills to make an impact

Required Qualifications

• Minimum 5 years of Project Management experience

• Minimum 5 years of experience delivering project, program, and portfolio management

• Minimum 5 years of experience consulting/supporting large scale, strategic initiatives

• Previous healthcare or managed care experience

• Experience in an Agile environment

• Proficient with MS Project, Visio, PowerPoint, and Excel

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Ability to travel up to 10% based on business needs within the US

Work-At-Home Requirements

• At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Undergraduate Degree

• PMP or Six Sigma Certifications

• SCRUM Master Certified

Additional Information

• Ability to travel up to 10% based on business needs within the US

• As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

• If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. This is a remote role - #LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$102,200 - $140,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.

The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. The medical director has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities.

Responsibilities

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed.

Use your skills to make an impact

Required Qualifications.

• MD or DO degree

• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

• Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.

• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.

• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

• Excellent verbal and written communication skills.

• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation).

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

• Experience with national guidelines such as MCGR or InterQual

• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization

• Advanced degree such as an MBA, MHA, or MPH

• Exposure to Public Health principles, Population Health, analytics, and use of business metrics.

• Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

• The curiosity to learn, the flexibility to adapt and the courage to innovate

Additional Information

Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

This is a remote position

#LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$199,400 - $274,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

We are seeking a highly skilled and motivated Business Intelligence Engineer 2 to join our Humana Enterprise Operations Enablement (EOE) - CPSS Data & Analytics - BI (Business Intelligence) team. A successful candidate will be responsible for developing and maintaining data visualization reports to connect actions to data sources to support business needs. This position will support the Group SSO (Specialty Service Organization) within Humana.

This Business Intelligence Engineer 2 requires the ability to work independently, gather and analyze requirements from business partners and delivery high-quality Business Intelligence Solutions.

Key Responsibilities :

• Develop, Implement, and maintain data visualizations (Through PowerBI and/or Tableau) reports and dashboards using multiple database (Microsoft and Oracle) sources

• Gather and analyze business requirements from various stakeholders to design effective solutions

• Optimize and maintain SQL queries to improve performance and efficiency

• Provide training and support to end-users on provided business solutions and other business intelligence tools

• Document processes, technical designs, and report configurations

Use your skills to make an impact

Required Qualifications

• Minimum of 2 or more years of experience in business intelligence, data analysis, or related field

• Proficiency in Microsoft SQL Server, including writing complex queries, stored procedures, and query tuning

• Strong experience in Power BI and/or Tableau developing and maintaining data visualization, reporting and dashboards

• Demonstrated ability to problem solve and provide solutions for business or data issues

• Strong communication and interpersonal skills

Preferred Qualifications

• Current or prior experience working with healthcare and/or insurance data ideally with specialty products such as Dental, Pharmacy, Vision, Term Life and/or Critical illness.

• Experience creating analytics solutions for various healthcare sectors

• Ability to use data to drive business outcomes and decisions

• Proficient in Power Apps and Power Automate regarding workflows and process automation

• Previous experience with data visualization: SSRS, SSIS, or other similar technologies

• Process Improvement methodology experience or Agile methodology experience working in sprints, daily stand-up calls etc..

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $89,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

We are seeking a highly skilled and motivated Business Intelligence Engineer 2 to join our Humana Enterprise Operations Enablement (EOE) - CPSS Data & Analytics - BI (Business Intelligence) team. A successful candidate will be responsible for developing and maintaining data visualization reports to connect actions to data sources to support business needs. This position will support the Group SSO (Specialty Service Organization) within Humana.

This Business Intelligence Engineer 2 requires the ability to work independently, gather and analyze requirements from business partners and delivery high-quality Business Intelligence Solutions.

Key Responsibilities :

• Develop, Implement, and maintain data visualizations (Through PowerBI and/or Tableau) reports and dashboards using multiple database (Microsoft and Oracle) sources

• Gather and analyze business requirements from various stakeholders to design effective solutions

• Optimize and maintain SQL queries to improve performance and efficiency

• Provide training and support to end-users on provided business solutions and other business intelligence tools

• Document processes, technical designs, and report configurations

Use your skills to make an impact

Required Qualifications

• Minimum of 2 or more years of experience in business intelligence, data analysis, or related field

• Proficiency in Microsoft SQL Server, including writing complex queries, stored procedures, and query tuning

• Strong experience in Power BI and/or Tableau developing and maintaining data visualization, reporting and dashboards

• Demonstrated ability to problem solve and provide solutions for business or data issues

• Strong communication and interpersonal skills

Preferred Qualifications

• Current or prior experience working with healthcare and/or insurance data ideally with specialty products such as Dental, Pharmacy, Vision, Term Life and/or Critical illness.

• Experience creating analytics solutions for various healthcare sectors

• Ability to use data to drive business outcomes and decisions

• Proficient in Power Apps and Power Automate regarding workflows and process automation

• Previous experience with data visualization: SSRS, SSIS, or other similar technologies

• Process Improvement methodology experience or Agile methodology experience working in sprints, daily stand-up calls etc..

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $89,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Agency Broker Lead focuses on hosting & coordinating (in cooperation with local Carrier Representatives and Agency Leaders) training opportunities for Agents in the market, along with virtual/remote webinars, etc. Works to support national and regional Partners to ensure there is a consistent Agent experience across all markets. on personal sales targets and troubleshoots specific customer problems. Meets targets through cultivation of new client relationships and development of productive relationships with existing clients. Prepares sales presentations, contracts, and proposals subject to review by supervisor. May participate in special projects/programs as assigned, such as training or communication sessions within or outside of the company. Maximizes revenues from sales of the organization's products and/or services through a base of reseller partners in specific assigned channels and/or vertical markets. Locates, evaluates, and recruits potential channel partners, including systems integrators, value-added resellers (VARs), distributors, dealers, or retailers. Supports partners throughout the sales process in all sales-oriented activities, including marketing, advertising, sales promotions, and training to achieve revenue targets. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Agency Broker Lead develops and maintains relationships with individual contributors, small, medium and large-sized accounts. The Agency Broker Lead work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Use your skills to make an impact

Required Qualifications

• 5+ years of experience in the Life Insurance industry with a focus on management/leadership

• Sales experience in the life solutions industry

• Active Life Insurance licenses

• Strong organizational, interpersonal, communication and presentation skills

• Ability to lead and train a team of sales associates, utilize technology tools and build relationships with communities and medical providers.

• High level of self-motivation and the ability to accomplish goals independently

• Great knowledge of Microsoft Word, Excel, Outlook and Power Point

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• This position requires approximately 50% or more travel with some overnight stays

• This role is part of Humana's Driver Safety Program and requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limit

Preferred Qualifications

• Bachelor's Degree

• Medicare Industry Experience

• Health License

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$75,000 - $103,200 per yearThis job is eligible for a commission incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work.

The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. The medical director has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.

The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities.

Responsibilities

The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Supports the assigned work with respect to market-wide objectives (e.g. Bold Goal) and community relations as directed.

Use your skills to make an impact

Required Qualifications.

• MD or DO degree

• 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).

• Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.

• A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.

• No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.

• Excellent verbal and written communication skills.

• Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation).

Preferred Qualifications

• Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.

• Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.

• Experience with national guidelines such as MCGR or InterQual

• Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specialization

• Advanced degree such as an MBA, MHA, or MPH

• Exposure to Public Health principles, Population Health, analytics, and use of business metrics.

• Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.

• The curiosity to learn, the flexibility to adapt and the courage to innovate

Additional Information

Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

This is a remote position

#LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$199,400 - $274,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

The Grievances & Appeals Representative 4:

• Assists members and supports quality related goals.

• A successful associate reviews the level 1 appeals cases and ensures that information is correct and then forwards all documentation to CMS review entity Maximus Federal Services for further review.

• They are expected to resolve member and practitioner issues to the best of their ability.

• Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals and is the primary administrative owner of a main process, program, product, or technology.

• Works within broad guidelines with little oversight.

Use your skills to make an impact

Required Work Schedule :

Training :

• Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00am-4:30pm EST, Monday - Friday.

• Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.

Work Schedule :

• Must be able to work any 8-hour shift Monday-Thursday between 8:00am and 9:00pm EST. With a minimum schedule of 10:00am-6:30pm EST on Friday.

• Weekend work required on rotating basis, 9:00am-5:30pm EST based on business needs. A 5% shift differential will be added for working a weekend.

• Overtime and Holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.

• Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.

Required Qualifications

• Minimum 1 year of Grievance & Appeals and/or relevant customer service experience

• Strong data entry skills required

• Intermediate experience with Microsoft Word and Excel

• Must have experience in a production driven environment

• Experience handling multiple projects and assignments as directed by Management

• Capacity to maintain confidentiality and work independently in support of the department

Preferred Qualifications

• Associate's or Bachelor's Degree

• Experience with electronic inventory management - able to complete assigned cases in a specified time frame

• Previous inbound call center or related customer service experience

• CAS and MedHOK experience strongly preferred

• Previous experience processing medical claims

• Medicare experience

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$43,400 - $59,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

Are you passionate about driving innovation and delivering top-notch products? Do you thrive in a fast-paced, dynamic environment where you can utilize your strategic thinking and product management expertise? If so, we have an exciting opportunity for you! Humana Digital Shopping team is seeking a Lead Product Manager.

In this role, you will be focused on building best in class digital experiences for consumers and members and will also lead Senior Product Managers. You will collaborate with cross-functional teams to develop and execute product initiatives that align with our organization's goals.

The Lead Product Manager is a key member of the Digital Shopping Team that conceives, develops, delivers, and manages products for customer use. The ideal candidate will be dynamic, a self-starter and leader who collaborates and influences effectively across different levels of the organization.

• Product Strategy: Collaborate with cross-functional teams to define the overall product strategy, aligning it with the company's goals and objectives. Conduct market research and gathers customer feedback to identify market trends and opportunities

• Product planning and road-mapping: Create and maintain a product roadmap that outlines the product vision, key features, and timeline for development. Prioritize product initiatives based on business impact, customer needs, and resource availability

• Cross-functional collaboration: Work closely with engineering, design, business intelligence, data science, content strategy, marketing, and sales teams to ensure successful product development and launch. Collaborate with engineering teams to define product requirements and oversee the development process

• Product development and launch: Manage the entire product development lifecycle, from ideation and prototyping to testing and launch. Coordinate with design teams to create intuitive and user-friendly product experiences

• Market analysis and competitive intelligence: Monitor market trends, competitive landscape, and customer needs to identify opportunities and potential threats. Conduct competitive analysis and benchmarking to ensure the company's products stand out in the market

• Product performance evaluation: Track and analyze product performance metrics, such as engagement and customer behavior. Make data-driven decisions to optimize product features and strategies

• Team leadership: Lead a team of Product Managers, providing guidance, support, and professional development opportunities. Foster a collaborative and innovative work environment

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree

• 8+ years of experience in strategy development, customer experience or product management

• At least 6 years of digital acquisition experience

• Prior healthcare experience

• Prior experience serving in a leadership capacity

• Strong organizational skills and experience in initiative and program planning and execution

• Demonstrated high learning agility and tolerance for ambiguity

• Proven solid collaboration and interpersonal skills to work effectively with cross-functional teams, stakeholders, and customers

• Ability to convey complex ideas, present product strategies and plans, and effectively communicate with stakeholders at all levels

Work-At-Home Information

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$123,800 - $170,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Senior Vendor Management Professional works as liaison between vendors and organization. The Senior Vendor Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Vendor Management Professional reviews and manages terms of vendor contracts and communicates with vendors to regarding day-to-day matters. Builds and maintains positive relationship with vendors and monitor vendor performance. Researches invoice and contractual issues and resolve discrepancies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact

Required Qualifications

• Associate's or Bachelor's degree

• Active and unencumbered RN licensure

• 3 or more years of experience in a healthcare or insurance setting

• Progressive operational experience

• Leadership experience over a large metric-intensive operational unit

• Proficient in Microsoft Office applications including Word, Excel and PowerPoint

• Strong verbal and written communication skills

• Strong facilitation skills

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree

• Certification with Six Sigma and/or the Project Management Institute

• Knowledge of Medicare Advantage

• Grievance and Appeals experience

Additional Information

Work Schedule: Monday - Friday 8:00 a.m. - 5:00 p.m CST

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work At Home / Internet Information:

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$69,800 - $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Provider Connectivity Professional 2 provides analysis and support to both internal and external customers on complex Electronic Data Interchange (EDI)-related issues (i.e., electronic exchange of data including authorizations/referrals, eligibility and benefits, electronic attachments and clearinghouse activities). The Provider Connectivity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Connectivity Professional 2 responds to complex inquiries relating to EDI from providers, vendors and internal departments. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Minimum of an Associate's degree

• Strong knowledge of Microsoft products to include Excel, Outlook, Word, Teams and/or PowerPoint

• Experience working with EDI (Electronic Data Interchange) systems

• Experience building reports (For example in Excel, Power B.I. or data software tools)

• Ability to work independently and in a self-guided/driven environment

• Ability to identify trends, communicate results, and make recommendations

• Excellent communication skills, both written and verbal

• Flexible and with the ability to adapt to change to support ongoing business needs

Preferred Qualifications

• Experience in HIPAA X12 transactions; Eligibility & Benefits and Referrals, SharePoint knowledge

• Experience working with healthcare related data (Insurance, Clinical, Provider, Managed care etc... )

• Strong knowledge of SQL, Access & Visio

• Knowledge of provider office processes and experience working in the provider space

• Experience building reports in SSRS, Tableau, Power BI or a similar tool

• Experience with querying and extracting data from different data sources to include EDW, SQL, and Access databases

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home/Remote Requirements

To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$52,500 - $72,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Senior Software Engineer solves complex business problems and issues using data from internal and external sources to provide insights to decision-makers. This associate will focus on delivering reliable and timely solutions in an approachable manner with a focus in building and maintain complex databases, ETL processes, and reporting for prioritized business requests impacting organizational and enterprise initiatives. This team is part of Member & Provider Analytics organization (MPA).

MPA incorporates principles of Scrum Agile, dedicated Partnership Leaders, and collective Product Ownership to deliver integrated risk adjustment (RA) and quality (Stars) solutions that leverage data and technology to empower members, providers, and Humana. MPA operates with a spirit of shared success whereby our ability to help business partners maximize the effectiveness and accuracy of their programs yields better member care, health outcomes, provider partnerships and the financing of benefits for Medicare Advantage beneficiaries.

The Senior Software Engineer on the Member and Provider Analytics (MPA) team will be a talented associate who will build relationships within MPA and with our customers to understand business needs and expectations. The candidate will deliver reliable and timely solutions in an approachable manner with a focus in building and maintain complex databases, ETL processes, and reporting for prioritized business requests impacting organizational and enterprise initiatives. The needs of our business segment change frequently, so the ideal candidate will leverage subject matter experts and other resources, clearly communicates across technical and business teams, and approaches resolving ambiguity to solve business problems with curiosity. This role requires taking the initiative to answer questions from customers by researching data and software. A successful candidate will be able to clearly explain the details of the work to both customers and the team. Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Key responsibilities:

• Establish and uphold the goals/expectations that support the fulfillment of culture and business objectives

• Operate with team-first mindset that is committed to ensuring the overall success of the team/organization

• Builds and maintains complex databases, ETL processes, and internal applications to support analytic and operational needs

• Contribute to moving the team towards cloud-based analytical platforms

• Ensure solutions provide the highest quality of data

• Consults with internal and external business partners on the development of business processes, metrics, and reporting

• Researches and recommends potential new technologies to implement and improve analytical procedures

Use your skills to make an impact

Required Qualifications

• Bachelor's degree or equivalent work experience

• 5+ years of technical experience in data analysis and/or engineering

• Advanced experience working with big and complex data sets within large organizations

• Design normalized relational databases optimal for application development and data reporting purposes. Fully understands query execution plans and optimization.

• Ability to develop modular, reusable code and tools

• Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs

• Highly proficient in verbal and written communication to operational areas and leadership

• Enthusiastic and self-motivated, with the ability to lead projects proactively

• Innovative and creative, balanced with a logical and methodical approach to problem solving

• Integrity - committed to ethical actions and decisions

Preferred Qualifications

• Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field

• Advanced experience in cloud-based platform Azure Synapse Analytics working with Notebook/Pipelines

• Expertise in automation using ASA, Python and SQL Server

• Experience in Microsoft Power Suite (PBI, Power Apps, Power Automate, Security & Access controls)

• Proficiency in understanding healthcare related data

• Previous experience with and knowledge around the CMS Stars and/or Risk Adjustment programs with a focus in Prospective Programs and Provider Education

• Broad understanding of our businesses and connectedness to key Humana constituent areas

• Knowledge of Humana's internal policies, procedures, and systems

• Experience navigating Humana compliance and security within Enterprise IT (EIP, EA, SecOps, )

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$104,800 - $144,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Agency Broker Lead focuses on hosting & coordinating (in cooperation with local Carrier Representatives and Agency Leaders) training opportunities for Agents in the market, along with virtual/remote webinars, etc. Works to support national and regional Partners to ensure there is a consistent Agent experience across all markets. on personal sales targets and troubleshoots specific customer problems. Meets targets through cultivation of new client relationships and development of productive relationships with existing clients. Prepares sales presentations, contracts, and proposals subject to review by supervisor. May participate in special projects/programs as assigned, such as training or communication sessions within or outside of the company. Maximizes revenues from sales of the organization's products and/or services through a base of reseller partners in specific assigned channels and/or vertical markets. Locates, evaluates, and recruits potential channel partners, including systems integrators, value-added resellers (VARs), distributors, dealers, or retailers. Supports partners throughout the sales process in all sales-oriented activities, including marketing, advertising, sales promotions, and training to achieve revenue targets. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Agency Broker Lead develops and maintains relationships with individual contributors, small, medium and large-sized accounts. The Agency Broker Lead work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Use your skills to make an impact

Required Qualifications

• 5+ years of experience in the Life Insurance industry with a focus on management/leadership

• Sales experience in the life solutions industry

• Active Life Insurance licenses

• Strong organizational, interpersonal, communication and presentation skills

• Ability to lead and train a team of sales associates, utilize technology tools and build relationships with communities and medical providers.

• High level of self-motivation and the ability to accomplish goals independently

• Great knowledge of Microsoft Word, Excel, Outlook and Power Point

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• This position requires approximately 50% or more travel with some overnight stays

• This role is part of Humana's Driver Safety Program and requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limit

Preferred Qualifications

• Bachelor's Degree

• Medicare Industry Experience

• Health License

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$75,000 - $103,200 per yearThis job is eligible for a commission incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Provider Connectivity Professional 2 provides analysis and support to both internal and external customers on complex Electronic Data Interchange (EDI)-related issues (i.e., electronic exchange of data including authorizations/referrals, eligibility and benefits, electronic attachments and clearinghouse activities). The Provider Connectivity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Connectivity Professional 2 responds to complex inquiries relating to EDI from providers, vendors and internal departments. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Minimum of an Associate's degree

• Strong knowledge of Microsoft products to include Excel, Outlook, Word, Teams and/or PowerPoint

• Experience working with EDI (Electronic Data Interchange) systems

• Experience building reports (For example in Excel, Power B.I. or data software tools)

• Ability to work independently and in a self-guided/driven environment

• Ability to identify trends, communicate results, and make recommendations

• Excellent communication skills, both written and verbal

• Flexible and with the ability to adapt to change to support ongoing business needs

Preferred Qualifications

• Experience in HIPAA X12 transactions; Eligibility & Benefits and Referrals, SharePoint knowledge

• Experience working with healthcare related data (Insurance, Clinical, Provider, Managed care etc... )

• Strong knowledge of SQL, Access & Visio

• Knowledge of provider office processes and experience working in the provider space

• Experience building reports in SSRS, Tableau, Power BI or a similar tool

• Experience with querying and extracting data from different data sources to include EDW, SQL, and Access databases

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home/Remote Requirements

To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$52,500 - $72,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Compliance Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree

• Ability to manage multiple or competing priorities and meet deadlines

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Strong attention to detail

Preferred Qualifications

• Compliance regulations experience

• Analytical experience

• Experience running queries and ad hoc reports in Access and/or SQL

• Graduate degree

• Utilization Management Review Experience

• Registered Nurse (RN) Credentials

• Home Health, Durable Medical Equipment, and/or Skilled Nursing Facility Experience

Additional Information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$57,700 - $79,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

We are seeking a highly skilled and motivated Business Intelligence Engineer 2 to join our Humana Enterprise Operations Enablement (EOE) - CPSS Data & Analytics - BI (Business Intelligence) team. A successful candidate will be responsible for developing and maintaining data visualization reports to connect actions to data sources to support business needs. This position will support the Group SSO (Specialty Service Organization) within Humana.

This Business Intelligence Engineer 2 requires the ability to work independently, gather and analyze requirements from business partners and delivery high-quality Business Intelligence Solutions.

Key Responsibilities :

• Develop, Implement, and maintain data visualizations (Through PowerBI and/or Tableau) reports and dashboards using multiple database (Microsoft and Oracle) sources

• Gather and analyze business requirements from various stakeholders to design effective solutions

• Optimize and maintain SQL queries to improve performance and efficiency

• Provide training and support to end-users on provided business solutions and other business intelligence tools

• Document processes, technical designs, and report configurations

Use your skills to make an impact

Required Qualifications

• Minimum of 2 or more years of experience in business intelligence, data analysis, or related field

• Proficiency in Microsoft SQL Server, including writing complex queries, stored procedures, and query tuning

• Strong experience in Power BI and/or Tableau developing and maintaining data visualization, reporting and dashboards

• Demonstrated ability to problem solve and provide solutions for business or data issues

• Strong communication and interpersonal skills

Preferred Qualifications

• Current or prior experience working with healthcare and/or insurance data ideally with specialty products such as Dental, Pharmacy, Vision, Term Life and/or Critical illness.

• Experience creating analytics solutions for various healthcare sectors

• Ability to use data to drive business outcomes and decisions

• Proficient in Power Apps and Power Automate regarding workflows and process automation

• Previous experience with data visualization: SSRS, SSIS, or other similar technologies

• Process Improvement methodology experience or Agile methodology experience working in sprints, daily stand-up calls etc..

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $89,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Manager, Business Intelligence for Membership and Plan Services will support the account services, enrollment, billing and reconciliation operational teams' automation efforts. The support includes identify unique insights and solving complex business challenges using a variety of data sources. The individual in this role will be expected to bring creativity and clearly articulate these insights, recommendations, and actions to a variety of key business decision makers within the business and drive results.

The Manager, Business Intelligence will utilize various tools, technologies, applications and best practices to analyze and present insightful, actionable information. This role oversees data & analytics team efforts to automation solutions with the objective of optimizing performance and improving member experience. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The role will lead a team of up to approx. 5-7 direct associates.

Key Responsibilities include :

• Lead and develop a tenured team focused on strategic understanding of install administration, enrollment, billing & reconciliation data, insight generation, automation and storytelling to support the business and improve member experience.

• Manage and prioritize requests from team members and cross functional partners and set realistic expectations. Transparently communicate about priorities on a regular basis.

• Embrace a service mentality to collaborate with Operations, Business Intelligence teams, Database teams, and IT to assure data processes are automated, efficient, and to identify insights and/or solve complex business challenges.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree in an analytical discipline such as statistics, mathematics, engineering, computer science or other business discipline

• Minimum 5 years of technical experience in data analysis and business intelligence

• Minimum 2 years of people leadership experience (Managing a team of 4 or more associates) in building, managing and developing high-performing business intelligence teams

• Demonstrated experience building and presenting story-driven presentations based on analytics

• Experienced working in a SQL environment with comprehensive knowledge of SSMS, SSIS and SSRS

• Strong working knowledge of Cloud Technologies (For example Azure Synapse Analytics, Snowflake and/or related cloud technology) and Power Platforms (Power BI, Power Automate, & Power Apps)

• Knowledgeable in process improvement and metrics development

• Knowledgeable in regulations governing health care industries or related adjacent industries

• Ability to be creative, anticipate and be proactive around next steps in large initiatives simultaneously

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcome.

• Experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.

• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences

• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome

• Collaborative with adjacent business intelligence and data science teams to drive results

Preferred Qualifications

• Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field

• Advanced in SQL, SAS and other data systems skills

• Experience creating analytics solutions for various healthcare sectors

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$104,800 - $144,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Manager, Business Intelligence for Membership and Plan Services will support the account services, enrollment, billing and reconciliation operational teams' automation efforts. The support includes identify unique insights and solving complex business challenges using a variety of data sources. The individual in this role will be expected to bring creativity and clearly articulate these insights, recommendations, and actions to a variety of key business decision makers within the business and drive results.

The Manager, Business Intelligence will utilize various tools, technologies, applications and best practices to analyze and present insightful, actionable information. This role oversees data & analytics team efforts to automation solutions with the objective of optimizing performance and improving member experience. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The role will lead a team of up to approx. 5-7 direct associates.

Key Responsibilities include :

• Lead and develop a tenured team focused on strategic understanding of install administration, enrollment, billing & reconciliation data, insight generation, automation and storytelling to support the business and improve member experience.

• Manage and prioritize requests from team members and cross functional partners and set realistic expectations. Transparently communicate about priorities on a regular basis.

• Embrace a service mentality to collaborate with Operations, Business Intelligence teams, Database teams, and IT to assure data processes are automated, efficient, and to identify insights and/or solve complex business challenges.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree in an analytical discipline such as statistics, mathematics, engineering, computer science or other business discipline

• Minimum 5 years of technical experience in data analysis and business intelligence

• Minimum 2 years of people leadership experience (Managing a team of 4 or more associates) in building, managing and developing high-performing business intelligence teams

• Demonstrated experience building and presenting story-driven presentations based on analytics

• Experienced working in a SQL environment with comprehensive knowledge of SSMS, SSIS and SSRS

• Strong working knowledge of Cloud Technologies (For example Azure Synapse Analytics, Snowflake and/or related cloud technology) and Power Platforms (Power BI, Power Automate, & Power Apps)

• Knowledgeable in process improvement and metrics development

• Knowledgeable in regulations governing health care industries or related adjacent industries

• Ability to be creative, anticipate and be proactive around next steps in large initiatives simultaneously

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcome.

• Experience in managing change by leading and energizing others, modeling adaptability, and inspiring strong organizational performance through periods of transformation, ambiguity, and complexity.

• Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences

• Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome

• Collaborative with adjacent business intelligence and data science teams to drive results

Preferred Qualifications

• Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field

• Advanced in SQL, SAS and other data systems skills

• Experience creating analytics solutions for various healthcare sectors

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

WAH Statement :

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$104,800 - $144,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This position provides the opportunity to lead/manage large cross-functional enterprise projects that impact our members, providers, vendors, and internal stakeholders.

Responsibilities Include:

• Designing, communicating, and implementing an operational plan for completing the project; monitoring progress and performance against the project plan; taking action to resolve operational problems and minimize delays

• Identifying, developing, and gathering the resources to complete the project

• Preparing designs and work specifications; developing project schedules, budgets, and forecasts; and selecting materials, equipment, project staff, and external contractors

• Communicating with other operational areas in the organization to secure specialized resources and contributions for the project

• Conducting meetings and preparing reports to communicate the status of the project.

• Setting priorities, allocating tasks, and coordinating project staff to meet project targets and milestones

• Advising executives to develop functional strategies (often segment specific) on matters of significance

Use your skills to make an impact

Required Qualifications

• Minimum 5 years of Project Management experience

• Minimum 5 years of experience delivering project, program, and portfolio management

• Minimum 5 years of experience consulting/supporting large scale, strategic initiatives

• Previous healthcare or managed care experience

• Experience in an Agile environment

• Proficient with MS Project, Visio, PowerPoint, and Excel

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Ability to travel up to 10% based on business needs within the US

Work-At-Home Requirements

• At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Undergraduate Degree

• PMP or Six Sigma Certifications

• SCRUM Master Certified

Additional Information

• Ability to travel up to 10% based on business needs within the US

• As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

• If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. This is a remote role - #LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$102,200 - $140,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

The Grievances & Appeals Representative 4:

• Assists members and supports quality related goals.

• A successful associate reviews the level 1 appeals cases and ensures that information is correct and then forwards all documentation to CMS review entity Maximus Federal Services for further review.

• They are expected to resolve member and practitioner issues to the best of their ability.

• Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals and is the primary administrative owner of a main process, program, product, or technology.

• Works within broad guidelines with little oversight.

Use your skills to make an impact

Required Work Schedule :

Training :

• Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00am-4:30pm EST, Monday - Friday.

• Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.

Work Schedule :

• Must be able to work any 8-hour shift Monday-Thursday between 8:00am and 9:00pm EST. With a minimum schedule of 10:00am-6:30pm EST on Friday.

• Weekend work required on rotating basis, 9:00am-5:30pm EST based on business needs. A 5% shift differential will be added for working a weekend.

• Overtime and Holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.

• Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.

Required Qualifications

• Minimum 1 year of Grievance & Appeals and/or relevant customer service experience

• Strong data entry skills required

• Intermediate experience with Microsoft Word and Excel

• Must have experience in a production driven environment

• Experience handling multiple projects and assignments as directed by Management

• Capacity to maintain confidentiality and work independently in support of the department

Preferred Qualifications

• Associate's or Bachelor's Degree

• Experience with electronic inventory management - able to complete assigned cases in a specified time frame

• Previous inbound call center or related customer service experience

• CAS and MedHOK experience strongly preferred

• Previous experience processing medical claims

• Medicare experience

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$43,400 - $59,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

The Grievances & Appeals Representative 4:

• Assists members and supports quality related goals.

• A successful associate reviews the level 1 appeals cases and ensures that information is correct and then forwards all documentation to CMS review entity Maximus Federal Services for further review.

• They are expected to resolve member and practitioner issues to the best of their ability.

• Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals and is the primary administrative owner of a main process, program, product, or technology.

• Works within broad guidelines with little oversight.

Use your skills to make an impact

Required Work Schedule :

Training :

• Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00am-4:30pm EST, Monday - Friday.

• Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.

Work Schedule :

• Must be able to work any 8-hour shift Monday-Thursday between 8:00am and 9:00pm EST. With a minimum schedule of 10:00am-6:30pm EST on Friday.

• Weekend work required on rotating basis, 9:00am-5:30pm EST based on business needs. A 5% shift differential will be added for working a weekend.

• Overtime and Holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.

• Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.

Required Qualifications

• Minimum 1 year of Grievance & Appeals and/or relevant customer service experience

• Strong data entry skills required

• Intermediate experience with Microsoft Word and Excel

• Must have experience in a production driven environment

• Experience handling multiple projects and assignments as directed by Management

• Capacity to maintain confidentiality and work independently in support of the department

Preferred Qualifications

• Associate's or Bachelor's Degree

• Experience with electronic inventory management - able to complete assigned cases in a specified time frame

• Previous inbound call center or related customer service experience

• CAS and MedHOK experience strongly preferred

• Previous experience processing medical claims

• Medicare experience

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$43,400 - $59,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Grievances & Appeals Representative 4 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal, or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 4 assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment.

The Grievances & Appeals Representative 4:

• Assists members and supports quality related goals.

• A successful associate reviews the level 1 appeals cases and ensures that information is correct and then forwards all documentation to CMS review entity Maximus Federal Services for further review.

• They are expected to resolve member and practitioner issues to the best of their ability.

• Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals and is the primary administrative owner of a main process, program, product, or technology.

• Works within broad guidelines with little oversight.

Use your skills to make an impact

Required Work Schedule :

Training :

• Virtual Training will start day one of employment and runs the first 6-8 weeks with a schedule of 8:00am-4:30pm EST, Monday - Friday.

• Attendance is vital for success, so no time off is allowed during training or within your first 120 days, with the exception of observed (and paid) company holidays.

Work Schedule :

• Must be able to work any 8-hour shift Monday-Thursday between 8:00am and 9:00pm EST. With a minimum schedule of 10:00am-6:30pm EST on Friday.

• Weekend work required on rotating basis, 9:00am-5:30pm EST based on business needs. A 5% shift differential will be added for working a weekend.

• Overtime and Holiday work may be required, however is only mandatory based on business needs. Voluntary overtime may also be available.

• Grievances and Appeals (G&A) has an impact to our business and because of the complexities of our work, there is an 18-month commitment to this department. G&A will not allow transitions outside of area prior to the end of the 18 months.

Required Qualifications

• Minimum 1 year of Grievance & Appeals and/or relevant customer service experience

• Strong data entry skills required

• Intermediate experience with Microsoft Word and Excel

• Must have experience in a production driven environment

• Experience handling multiple projects and assignments as directed by Management

• Capacity to maintain confidentiality and work independently in support of the department

Preferred Qualifications

• Associate's or Bachelor's Degree

• Experience with electronic inventory management - able to complete assigned cases in a specified time frame

• Previous inbound call center or related customer service experience

• CAS and MedHOK experience strongly preferred

• Previous experience processing medical claims

• Medicare experience

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$43,400 - $59,600 per year

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. This position provides the opportunity to lead/manage large cross-functional enterprise projects that impact our members, providers, vendors, and internal stakeholders.

Responsibilities Include:

• Designing, communicating, and implementing an operational plan for completing the project; monitoring progress and performance against the project plan; taking action to resolve operational problems and minimize delays

• Identifying, developing, and gathering the resources to complete the project

• Preparing designs and work specifications; developing project schedules, budgets, and forecasts; and selecting materials, equipment, project staff, and external contractors

• Communicating with other operational areas in the organization to secure specialized resources and contributions for the project

• Conducting meetings and preparing reports to communicate the status of the project.

• Setting priorities, allocating tasks, and coordinating project staff to meet project targets and milestones

• Advising executives to develop functional strategies (often segment specific) on matters of significance

Use your skills to make an impact

Required Qualifications

• Minimum 5 years of Project Management experience

• Minimum 5 years of experience delivering project, program, and portfolio management

• Minimum 5 years of experience consulting/supporting large scale, strategic initiatives

• Previous healthcare or managed care experience

• Experience in an Agile environment

• Proficient with MS Project, Visio, PowerPoint, and Excel

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Ability to travel up to 10% based on business needs within the US

Work-At-Home Requirements

• At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

• Undergraduate Degree

• PMP or Six Sigma Certifications

• SCRUM Master Certified

Additional Information

• Ability to travel up to 10% based on business needs within the US

• As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

• If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. This is a remote role - #LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$102,200 - $140,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Senior Vendor Management Professional works as liaison between vendors and organization. The Senior Vendor Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Vendor Management Professional reviews and manages terms of vendor contracts and communicates with vendors to regarding day-to-day matters. Builds and maintains positive relationship with vendors and monitor vendor performance. Researches invoice and contractual issues and resolve discrepancies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact

Required Qualifications

• Associate's or Bachelor's degree

• Active and unencumbered RN licensure

• 3 or more years of experience in a healthcare or insurance setting

• Progressive operational experience

• Leadership experience over a large metric-intensive operational unit

• Proficient in Microsoft Office applications including Word, Excel and PowerPoint

• Strong verbal and written communication skills

• Strong facilitation skills

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree

• Certification with Six Sigma and/or the Project Management Institute

• Knowledge of Medicare Advantage

• Grievance and Appeals experience

Additional Information

Work Schedule: Monday - Friday 8:00 a.m. - 5:00 p.m CST

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work At Home / Internet Information:

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$69,800 - $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Provider Connectivity Professional 2 provides analysis and support to both internal and external customers on complex Electronic Data Interchange (EDI)-related issues (i.e., electronic exchange of data including authorizations/referrals, eligibility and benefits, electronic attachments and clearinghouse activities). The Provider Connectivity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Provider Connectivity Professional 2 responds to complex inquiries relating to EDI from providers, vendors and internal departments. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Minimum of an Associate's degree

• Strong knowledge of Microsoft products to include Excel, Outlook, Word, Teams and/or PowerPoint

• Experience working with EDI (Electronic Data Interchange) systems

• Experience building reports (For example in Excel, Power B.I. or data software tools)

• Ability to work independently and in a self-guided/driven environment

• Ability to identify trends, communicate results, and make recommendations

• Excellent communication skills, both written and verbal

• Flexible and with the ability to adapt to change to support ongoing business needs

Preferred Qualifications

• Experience in HIPAA X12 transactions; Eligibility & Benefits and Referrals, SharePoint knowledge

• Experience working with healthcare related data (Insurance, Clinical, Provider, Managed care etc... )

• Strong knowledge of SQL, Access & Visio

• Knowledge of provider office processes and experience working in the provider space

• Experience building reports in SSRS, Tableau, Power BI or a similar tool

• Experience with querying and extracting data from different data sources to include EDW, SQL, and Access databases

Additional Information

Work Style : Remote

HireVue Statement : As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home/Remote Requirements

To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$52,500 - $72,300 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana

Job Description

Become a part of our caring community and help us put health first

The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Compliance Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree

• Ability to manage multiple or competing priorities and meet deadlines

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Strong attention to detail

Preferred Qualifications

• Compliance regulations experience

• Analytical experience

• Experience running queries and ad hoc reports in Access and/or SQL

• Graduate degree

• Utilization Management Review Experience

• Registered Nurse (RN) Credentials

• Home Health, Durable Medical Equipment, and/or Skilled Nursing Facility Experience

Additional Information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$57,700 - $79,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Job Detail

• Company:
  Humana