The Business Operations Analyst supports Licensing, Contracting, and the Operations Support Teams by monitoring performance metrics, identifying bottlenecks, and providing data-driven insights. This role conducts quality and compliance audits, evaluates regulatory impacts, and tracks trends such as agent fallout and renewal risks. The analyst ensures accuracy across systems like AgentSync and the CRM, delivering actionable intelligence that improves efficiency, reduces risk, and strengthens overall operational compliance. This position requires a hybrid schedule reporting to our Shelton, CT location 3 days a week.
Supervisory Responsibilities: None
Duties/Responsibilities:
Collaborate with team members and stakeholders to support operational performance monitoring and reporting.
Assist in tracking licensing and policy turnaround times, backlogs, expenses, and approval rates to ensure accuracy and timeliness.
Help analyze workload capacity and contribute to forecasting for inbound and outbound volume.
Perform root-cause analysis under guidance to identify operational bottlenecks and recommend basic improvements.
Conduct accuracy checks and audits for Licensing, Contracting, Enrollment, and call lists; escalate discrepancies as needed.
Support assessment of operational impacts from regulatory changes, including State DOI rules.
Monitor agent fallout and drop-off trends; assist in identifying renewal lapses and high-risk expirations for proactive follow-up.
Perform cost analysis for license renewals and maintain supporting documentation.
Validate data accuracy across AgentSync, CRM systems, and related platforms; flag anomalies for review.
Provide timely updates to team leads on reporting status, audit timelines, and identified issues.
Perform other related duties as assigned.
Required Skills/Abilities:
Bachelor's degree in Business, Finance, Economics, or a related field.
Minimum 2 years of analyst experience
Proficiency in building reports, tracking KPIs, and communicating operational performance metrics in a clear, actionable manner.
Ability to analyze workload patterns and support forecasting for staffing and volume planning.
Comfortable using operational systems such as AgentSync, CRM tools, Excel/Sheets, and BI/reporting platforms
Ability to work effectively with Operations, Compliance, Finance, Technology, and Licensing teams to gather data, resolve issues, and support process improvements
Strong ability to manage multiple priorities, maintain documentation, and oversee ongoing monitoring of performance metrics.
Excellent written and verbal communication, able to translate data insights into actionable recommendations for leadership and cross-functional partners.
Preferred Skills/Abilities:
Knowledge of Medicare Health Insurance industry, products, compliance, and operations
Physical Requirements:
Must be able to remain in a stationary position (e.g., sitting or standing) for extended periods of time, typically in a cubicle environment (constant noise, fluorescent overhead lighting)
Frequent use of a computer, dual monitors, keyboard, mouse, and other standard office equipment such as a telephone, copier, and printer.
Must be able to communicate effectively, including exchanging information in person, in writing, by telephone, email or video conferencing.
Visual and auditory acuity required to perform job duties effectively, including reading, writing, and interpreting information on screens or in print.
Hand dexterity, fine motor skills needed to operate a keyboard and mouse efficiently
Reach with hands and arms occasionally
For Hybrid Roles:
Must be able to commute to an office setting as required, which may include walking short distances and navigating an office environment.
Occasionally moves about the office to access files, office machinery, and meet with others.
$57k-78k yearly est. 1d ago
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Manager Licensing Support
Healthplanone 4.2
Healthplanone job in Shelton, CT
HealthPlanOne's mission is to help people find the right health insurance at the right price, so they live healthier lives. We are committed to making the shopping process simpler. Our mission has never been more important than it is today.
Oversee state licensing for agents and agency/principal entities, including initial orders, renewals, and CE compliance. This leader owns the AgentSync vendor relationship. They Maintain accurate license data in AgentSync, manage system updates, reporting, and act as the internal SME on licensing, DOI, and FINRA regulations. Drive licensing policy governance, process improvements, and partner with HR on licensing-related hiring or terminations. Oversees employee productivity, training, carrier development to support team growth and operational excellence.
Supervisory Responsibilities: Team of support specialists and one team lead
Duties/Responsibilities:
Manage agent state license ordering (initial and renewals)
Oversee all Agency and principal licenses (entity licenses) are properly credentialed
Manage CE compliance tracking and remediation
Manage Affiliation and affidavits processing
License data accuracy and maintenance within AgentSync (SME)
Day to day AgentSync relationship and system changes/trainings
Licensing policy governance & continuous improvement
Act as a SME to all internal partners for license concerns regarding DOI issues, insurance regulations issues (FINRA's)
Assists in managing budget and helps to control expenses while meeting licensing operational requirements
Partners with HR regarding NHC's no hire/term conversations regarding licensing roadblocks
Oversee employee productivity, training, and personal/career growth
Performs other related duties as assigned
Required Skills/Abilities:
•` Bachelor's degree or equivalent experience
4+ years in a managerial position driving results and taking initiative (prioritizing workload/projects, creating and implementing process), tracking team metrics
6+ years state DOI licensing experience regarding licensing requirements for agents and agency/principal entities
4+ years with AgentSync or similar licensing management systems
Understanding of CE compliance and remediation processes
Strong grasp of DOI regulations and FINRA compliance standards
Excellent communication and collaboration skills to work with HR, leadership, and cross-functional teams
Leadership skills to mentor staff, monitor productivity, and support professional growth
Detail-oriented, organized, and capable of managing multiple priorities under tight deadlines
Intermediate to advanced proficiency with Microsoft Excel (V-Lookup and pivot tables, Macros)
Strong organizational skills with the ability to manage multiple priorities and projects simultaneously
Physical Requirements:
Must be able to remain in a stationary position (e.g., sitting or standing) for extended periods of time, typically in a cubicle environment (constant noise, fluorescent overhead lighting)
Frequent use of a computer, dual monitors, keyboard, mouse, and other standard office equipment such as a telephone, copier, and printer.
Must be able to communicate effectively, including exchanging information in person, in writing, by telephone, email or video conferencing.
Visual and auditory acuity required to perform job duties effectively, including reading, writing, and interpreting information on screens or in print.
Hand dexterity, fine motor skills needed to operate a keyboard and mouse efficiently
Reach with hands and arms occasionally
For Hybrid Roles:
Must be able to commute to an office setting as required, which may include walking short distances and navigating an office environment.
Occasionally moves about the office to access files, office machinery, and meet with others.
Equal Employment Opportunity (EEO) is a fundamental principle at HealthPlanOne, where employment is based upon personal capabilities and qualifications. HealthPlanOne does not discriminate because of actual or perceived sex, sexual orientation or preference, gender identity, gender, transgender, race, color, religion, national origin, creed, citizenship status, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, medical conditions including genetic characteristics, mental or physical disability, military and veteran status, or any other protected characteristic as established by law. HealthPlanOne requires the necessary drug testing and background checks as part of our pre-employment practices. If you need assistance or an accommodation due to a disability, please contact us to request accommodation at ************
$94k-126k yearly est. 2d ago
Director, Product Management - CenterWell Pharmacy Digital
Humana Inc. 4.8
Remote or Hartford, CT job
Become a part of our caring community and help us put health first
The Director, Product Management for CenterWell Pharmacy Digital leads the strategic vision, development, and delivery of CenterWell Pharmacy's website and mobile app experiences. This role is responsible for defining product strategy, driving innovation, and ensuring seamless, user‑centric digital solutions that support our patients' pharmacy needs and drive business objectives, including accelerating growth in payor agnostic markets. Additionally, the Director will lead a team of Product Owners (POs) and Product Managers (PMs), support their professional growth and development, and actively assist them in identifying and resolving risks and blockers that may impact product delivery and team performance.
This role reports to the AVP of CenterWell Digital and collaborates closely with supporting CenterWell Pharmacy product teams, operational and service teams, and the executive leadership team. The Director is expected to be a strategic leader and a hands‑on problem solver, driving member engagement, satisfaction, and payor agnostic digital growth through innovation and alignment with enterprise business strategies.
Key Responsibilities:
Develop and articulate a clear product vision and strategy for CenterWell Pharmacy's digital channels, aligning with organizational goals, patient needs, and business growth priorities.
Ensure product development efforts are tightly aligned with business growth strategy and key outcomes, supporting both membership growth and expansion in payor agnostic opportunities.
Drive digital growth in payor agnostic areas by identifying, prioritizing, and executing capabilities that expand CenterWell Pharmacy's reach beyond Humana membership.
Lead cross‑functional working partnership-including engineering, UX/UI, marketing, and operations-to deliver high‑quality digital products on time and within budget.
Lead and mentor a team of Product Owners and Product Managers, supporting their ongoing growth, skill development, and career progression.
Work closely with team members to proactively address risks, remove blockers, and foster a collaborative environment focused on delivering key business outcomes.
Own the digital product roadmap; prioritize initiatives using data‑driven insights, customer feedback, market trends, and strategic business outcomes.
Establish and monitor key performance indicators (KPIs) to measure product effectiveness, member satisfaction, script growth, and overall business impact.
Partner with stakeholders across Pharmacy Operations, Engineering, Compliance, and Customer Service to ensure solutions meet regulatory standards and operational requirements.
Oversee the product lifecycle: ideation, discovery, refinement, development, launch, and optimization.
Champion a culture of continuous improvement, leveraging agile methodologies and best practices in product management.
Represent CenterWell Pharmacy's digital product vision with senior leadership and external partners.
Stay informed on the latest in healthcare, pharmacy, and digital trends to inform product strategy and vision.
Use your skills to make an impact
Qualifications:
Bachelor's degree in Communication, Business, Pharmacy, or related field.
A minimum of eight years of experience in product management, with at least 3 years leading digital products in healthcare, pharmacy, or a related field.
Proven experience managing web and mobile product portfolios, ideally in a regulated environment.
Demonstrated ability to lead and develop high‑performing teams.
Strong analytical, strategic thinking, and communication skills.
Familiarity with regulatory requirements for pharmacy and healthcare digital platforms.
Experience working with agile development teams and tools.
Preferred:
Experience leading digital products in Centerwell pharmacy
Additional Information
Remote role
Work at Home Requirements
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
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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.
$168,000 - $231,000 per year
This 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.
Application Deadline: 01-23-2026
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
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$36k-45k yearly est. 3d ago
Provider Relations Coordinator
Unitedhealth Group 4.6
Hartford, CT job
_This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges._ Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
The **Provider Relations Coordinator** is responsible for supporting the HouseCalls Advance Practice Clinician Network from a logistical and operational perspective. Employees in this position will primarily work via telephone and email to address real-time practitioner concerns and assist with data entry.
The Provider Relations Coordinator will report to the Manager, HouseCalls Provider Relations, supporting short- and long-term operational goals by executing on daily responsibilities and providing support to the overall team.
This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 11:00am - 7:30pm EST.
We offer 2 weeks of training. The hours of training will be based on your schedule or will be discussed on your first day of employment.
**Primary Responsibilities:**
+ Resolve operational issues that are routed to the Provider Relations team either telephonically or via e-mail
+ Aid HouseCalls Practitioners in real time through telephone and email
+ Complete Data Entry tasks
+ Achieve performance metrics related to operational processes and standards
+ Other duties as assigned
**A successful candidate will:**
+ Possess strong communication and interpersonal skills
+ Be able to work in both collaborative and autonomous settings
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ High School Diploma / GED
+ Must be 18 years of age OR older
+ 2+ years of Customer Service orientation/experience
+ Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 11:00am - 7:30pm EST
**Preferred Qualifications:**
+ 1+ years of experience with Microsoft Excel including basic formulas, analyzing data, filtering and sorting
+ Experience with Data Analysis
+ Experience with Operational Support
**Telecommuting Requirements:**
+ Ability to keep all company sensitive documents secure (if applicable)
+ Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
+ Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
**_Application Deadline:_** _This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants._
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$20-35.7 hourly 3d ago
Senior Value-Based Programs Professional
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Senior Value-Based Programs Professional supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Professional works on problems of diverse scope and complexity ranging from moderate to substantial.
**Key Responsibilities:**
+ Administer new and existing innovative VBP models for range of provider types, such as primary care physicians, hospitals, behavioral health, maternity, and other specialists to move providers from volume to value
+ Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care
+ Scorecard creation and reconciliation of provider performance based on contractual terms
+ Analyze utilization data to reconcile provider disputes
+ Contribute to development and support of provider reporting packages to help providers understand their overall performance
+ Collaborate with cross functional and matrixed teams to operationalize and rollout new VBP models.
**Use your skills to make an impact**
**Required Qualifications**
+ 3+ years of experience in managed care operations, provider reimbursement and analytics, and value-based care
+ In-depth knowledge of VBP model support including analyzing provider performance, reporting, and scorecard/reconciliation reporting
+ Understanding of Medicaid and/or Medicaid managed care
+ Ability to understand and analyze financial, utilization, and performance data
+ Ability to identify, structure and solve moderately complex business problems
+ Experience operating in a matrixed environment
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Bachelor's Degree.
+ Expertise in VBP financial modeling and impact analysis.
+ Experience performing claims data analysis to inform VBP provider performance.
+ Experience in SQL, SAS, PowerBI and/or Tableau.
**Additional Information**
+ **Schedule:** Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).
+ **Work Location:** US Nationwide (Stateside only)
+ **Work Style:** Remote
+ **Travel Requirements:** Minimal travel possibly outside of your state of residence for face-to-face meetings and collaborations.
**Work at Home Internet Statement**
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
**Interview Format**
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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$78,400 - $107,800 per year
This 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.
Application Deadline: 01-19-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$78.4k-107.8k yearly 2d ago
Inpatient Medical Coding Auditor
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Where you Come In
Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG).
The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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**
**WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs.
**Required Qualifications | What it takes to Succeed**
- RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
- MS-DRG coding/auditing experience
- Experience reading and interpreting claims
- Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings
- Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
- Strong attention to detail
- Can work independently and determine appropriate course of action
- Ability to handle multiple priorities
- Capacity to maintain confidentiality
- Excellent communication skills both written and verbal
**Preferred Qualifications**
- Experience in APR DRG coding/auditing
- Experience in Financial Recovery
- Experience in a fast paced, metric driven operational setting
**Additional Information**
**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
**Interview Format**
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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 to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$71,100 - $97,800 per year
This 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.
Application Deadline: 01-12-2035
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$71.1k-97.8k yearly 24d ago
Lead Data Scientist - Safety Alignment
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Enterprise AI organization at Humana is a pioneering force, driving AI innovation across our Insurance and CenterWell business segments. By collaborating with world-leading experts, we are at the forefront of delivering cutting-edge AI technologies for improving care quality and experience of millions of consumers. We are actively seeking top talent to develop robust and reusable AI modules and pipelines, ensuring adherence to best practices in accountable AI for effective risk management and measurement. Join us in shaping the future of healthcare through AI excellence.
We are seeking a Lead Data Scientist to drive the safety, alignment, and ethical development of Agentic AI systems. You will lead initiatives to ensure our intelligent agents behave reliably, safely, and in accordance with human values across dynamic, multi-agent, and high-stakes environments. This is a cross-functional role bridging technical safety research, systems engineering, governance, and product implementation.
**Key responsibilities**
+ Design and implement safety architectures for Agentic AI systems, including guardrails, reward modeling, and self-monitoring capabilities
+ Lead and collaborate on alignment techniques such as inverse reinforcement learning, preference learning, interpretability tools, and human-in-the-loop evaluation
+ Develop continuous monitoring strategies for agent behavior in both simulated and real-world environments
+ Partner with product, legal, Responsible AI, governance, and deployment teams to ensure responsible scaling and deployment
+ Contribute to and publish novel research on alignment of LLM-based agents, multi-agent cooperation/conflict, or value learning
+ Proactively identify and mitigate failure modes, e.g., goal misgeneralization, deceptive behavior, unintended instrumental actions
+ Set safety milestones for autonomous capabilities as part of deployment readiness reviews
**Technical skills**
+ Proficiency in SQL, Python, and data analysis/data mining tools.
+ Experience with machine learning frameworks like PyTorch, JAX, ReAct, LangChain, LangGraph, or AutoGen
+ Experience with high performance, large-scale ML systems
+ Experience with deploying or auditing LLM-based agents or multi-agent AI systems
+ Experience with large-scale ETL
**Use your skills to make an impact**
**Required Qualifications**
+ Master's Degree and 4+ years of experience in research/ML engineering or an applied research scientist position preferably with a focus on developing production-ready AI solutions
+ 2+ years of experience leading development of AI/ML systems
+ Deep expertise in AI alignment, multi-agent systems, or reinforcement learning
+ Demonstrated ability to lead research-to-production initiatives or technical governance frameworks
+ Strong publication or contribution record in AI safety, interoperability, or algorithm ethics
**Preferred Qualifications**
+ Ph.D. in Computer Science, Data Science, Machine Learning, or a related field
+ Contributions to open-source AI safety tools or benchmarks
+ Understanding of value-sensitive design, constitutional AI, or multi-agent alignment
+ Experience in regulated domains such as healthcare, finance, or defense
**Additional Information**
**Location/Work Style:** Remote US
**Why Humana?**
At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:
+ Work-Life Balance
+ Generous PTO package
+ Health benefits effective day 1
+ Annual Incentive Plan
+ 401K - Excellent company match
+ Well-being program
+ Paid Volunteer Time Off
If you share our passion for helping people, we likely have the right place for you at Humana.
**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
**SSN Alert Statement**
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 ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$142,300 - $195,700 per year
This 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.
Application Deadline: 01-29-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$142.3k-195.7k yearly Easy Apply 60d+ ago
Senior PPI Professional - Inpatient Coding Disputes
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Senior Payment Integrity Professional - Inpatient Coding Disputes on the Disputes Team consults and collaborates with coding professionals across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality.
+ Will be a SME (Subject Matter Expert) medical coder with in-depth experience in inpatient coding audits (MSDRG/APDRG)
+ Contributes to overall accuracy and compliance of coding disputes reviews ensuring that all appropriate coding guidelines are adhered to and will be able to speak to inpatient coding review outcomes to a variety of audiences
+ Leverages advanced auditing expertise to guide onshore and offshore DRG coding disputes auditors, reviews disputes escalations and clarification requests
+ Manages multiple priorities, collaborates across teams, and ensures timely, accurate inventory management
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
+ Medical Benefits
+ Dental Benefits
+ Vision Benefits
+ Health Savings Accounts
+ Flex Spending Accounts
+ Life Insurance
+ 401(k)
+ PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
+ And more
**Use your skills to make an impact**
**Required Qualifications**
+ 5+ years holding **one** of these Coding Credentials from AHIMA: **CCS/** **RHIT/ RHIA**
+ 5+ years' work experience reading and interpreting claims
+ 2+ years verifiable experience in MSDRG disputes/audits
+ 2+ years of verifiable SME and/or leadership experience within the last few years in provider/payer inpatient auditing
+ Verifiable experience working with and supporting onshore and offshore MSDRG vendors/ staff
+ Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
+ Excellent communication skills both written and verbal
+ High level of productivity with the ability to turn-around requests quickly and effectively
+ Strong attention to detail
**Preferred Qualifications**
+ Experience leading people, projects, and/or processes
+ Experience in Financial Recovery
+ Experience in a fast paced, metric driven operational setting
**Additional Information**
Work at Home/Remote Requirements
**Work-At-Home Requirements**
+ 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 to support Humana applications, per associate.
+ Wireless, Wired Cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. 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
**Our Hiring Process**
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
\#LI-LM1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$71,100 - $97,800 per year
This 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.
Application Deadline: 01-21-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$71.1k-97.8k yearly 3d ago
Phlebotomist
Unitedhealth Group 4.6
Meriden, CT job
Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
The **Phlebotomist** performs venipuncture and capillary puncture on adults and pediatric patients; collects urine specimens; participates in the instruction of new personnel; works with computers; communicates in a manner that promotes laboratory professionalism as well as a comfortable experience. The **Phlebotomist** also processes lab specimens. May be asked to cover another practice if/when needed.
**Schedule:** This is a 40 **-** hour work week Monday through Friday, 8am - 4:30pm.
**Location:** 816 Broad St. Ste 24 Meriden, CT 06450
**Primary Responsibilities:**
+ Perform routine phlebotomy procedures
+ Ability to distinguish sample types and draw requirements with order of draw for lab testing
+ Navigate laboratory computer system with minimal to no errors
+ Perform pediatric and adult phlebotomy
+ Obtain finger stick collection
+ Verify patient demographics accurately with two patient identifiers
+ Adhere to safety and scientifically accepted infection control practices and standards
+ Blood collection: from adult and pediatric patients using vacutainer, syringe and butterfly techniques; capillary puncture using heel and fingerstick techniques
+ Identifies and labels specimens appropriately
+ Instruct patients regarding urine and stool collection procedures
+ Enters accessing data into the computer
+ Prepares specimens for sending out testing
+ Inventories supply and prepare phlebotomy stations to effectively collect blood
+ Attends required meetings
+ Function as an effective team member
+ Work cooperatively alongside physicians, nurses and other ancillary staff
+ Display effective communication
+ Maintain pace of over 4-6 patients per hour
+ Enhances professional growth and development through in service meetings and education programs
+ Maintains patient confidentiality
+ Performs related work as required
+ Provide quality customer service to the patients and visitors courteously and promptly
+ Must possess solid interpersonal skills to communicate effectively with co-workers, Management Staff, and Physicians
+ Must be able to work effectively and cooperatively as a team member, balancing both the support of the physician(s) and following the financial policies established by Optum
+ Demonstrate professionalism in appearance and actions with patients, staff, Physicians and Administrators always
+ Maintains confidentiality of patient information
+ Travel to all other draw stations and perform all tasks
+ Troubleshoot problems within LIS and partner with LIS team to resolve outstanding issues
+ Including but not limited to:
+ Follow handwashing protocols
+ Practice aseptic techniques
+ Utilize protective barriers
+ Utilize personal protective equipment, e.g. gloves, lab coats
+ Maintain proper disposal of hazardous materials
+ Demonstrate knowledge of role in emergency disaster
+ Maintain pace of over 4-6 patients per hour
+ Travel to all other draw stations and perform all tasks
+ Performs other duties as assigned
**What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:**
+ Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
+ Medical Plan options along with participation in a Health Spending Account or a Health Saving account
+ Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
+ 401(k) Savings Plan, Employee Stock Purchase Plan
+ Education Reimbursement
+ Employee Discounts
+ Employee Assistance Program
+ Employee Referral Bonus Program
+ Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
+ More information can be downloaded at: *************************
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ High School Diploma/GED (or higher)
+ Phlebotomy certified
+ 1+ years of experience of drawing blood
+ Beginner level of proficiency in Microsoft Office and demonstrates solid computer skills
+ Access to reliable transportation and valid US driver's license
**Preferred Qualifications:**
+ 1+ years of EPIC experience
+ Previous laboratory experience
+ Pediatrics Phlebotomy experience
+ Bilingual Spanish
**Soft Skills:**
+ Ability to work independently and maintain good judgment and accountability
+ Ability to acclimate working on a small or large team
+ Demonstrated ability to work well with health care providers
+ Strong organizational and time management skills
+ Ability to multi-task and prioritize tasks to meet all deadlines
+ Ability to work well under pressure in a fast-paced environment
+ Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying information in a manner that others can understand, as well as ability to understand and interpret information from others
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
\#RPO #RED
$16-27.7 hourly 9d ago
Pharmacy Stars Improvement Lead
Humana 4.8
Hartford, CT job
**Become a part of our caring community and help us put health first** The Pharmacy Stars Improvement Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana's Stars patient safety measure performance. The Pharmacy Stars Improvement Lead will autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use with specific focus on telehealth and in-home methods of care delivery. The Pharmacy Stars Improvement Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's Degree in Business, Finance, Health Care or a related field
+ 2 or more years of project leadership experience
+ Prior Medicare/Medicaid experience
+ Strategic thinking and planning capabilities; organized and detail-oriented
+ Excellent communication skills
+ Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written)
+ Ability to operate under tight deadlines
+ Successful track record in facilitating and consulting across teams and managing projects
+ Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need
+ Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
+ Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
**Preferred Qualifications**
+ Master's Degree in Business Administration, Health Administration or a related field
+ Provider relations experience
+ Prior managed care experience
+ Understanding of metrics, trends and the ability to analyze and identify gaps in care
+ Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus
+ Understanding of CMS Stars and performance measure knowledge and experience a plus
+ Background working in quality improvements
**Additional 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.
**Work at home requirements:**
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 required; 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 ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$104,000 - $143,000 per year
This 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.
Application Deadline: 01-15-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$104k-143k yearly Easy Apply 16d ago
Director, Digital Product - Healthcare Growth (Remote)
Humana Inc. 4.8
Remote or Hartford, CT job
A leading healthcare company is seeking a Director of Product Management to oversee digital product strategy for its pharmacy services. The role involves developing product visions aligned with business growth and leading cross-functional teams to ensure timely delivery of digital solutions. Candidates should have a strong background in healthcare product management, excellent leadership skills, and experience in agile methodologies. The position is remote with occasional travel required and offers a competitive salary range of $168,000 - $231,000 per year.
#J-18808-Ljbffr
$168k-231k yearly 3d ago
Senior Cloud Solutions Engineer
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer participates in the design and development of cloud-based solutions and applications in the big data space within Humana's Digital & Data organization primarily using Microsoft Azure and related technologies. The Senior Cloud Solutions Engineer 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 Cloud Solutions Engineer implements the organization's cloud strategy from a technical perspective, including design, planning, integration, and maintenance for big data solutions using Microsoft Azure. This will involve participating in the design and development of cloud-based solutions and applications within Humana's Digital & Data organization primarily using Microsoft Azure.
Responsibilities Include:
+ Work with stakeholders across organization to evaluate cloud systems and identify appropriate solutions.
+ Collaborates with product managers and engineers to develop specifications for new cloud-based products/services, applications and solutions.
+ Drives the roll-out of cloud management platforms, evaluates its performance and implements enhancements. 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**
+ Bachelor's degree in Computer Science, a related field, or equivalent professional experience.
+ Proven experience designing and implementing cloud-based big data solutions using Azure, AWS, or GCP.
+ Minimum of 6 years of experience in cloud application design, development, and testing.
+ At least 3 years of hands-on experience working with Databricks, Azure Data Factory, and Azure Synapse Analytics.
+ Proficient in ETL processes, SQL, and PySpark for data integration and transformation tasks.
+ Experience with version control systems (such as Git) and managing release pipelines.
+ Demonstrated commitment to enhancing consumer experiences and supporting continuous organizational improvement.
+ One or more professional certifications in Azure, Databricks, or other major cloud platforms.
**Preferred Qualifications**
+ Master's Degree
+ Databricks experience
+ Python experience
**Work-At-Home Requirements**
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
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$106,900 - $147,000 per year
This 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.
Application Deadline: 01-13-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$106.9k-147k yearly 60d+ ago
Senior Coding Educator
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups.
+ Analyzes data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements.
+ Collaboration with relationship owners and HQRI
+ Research data and workflow processes and arranges educational sessions with providers aimed at quality of care and documentation improvements.
+ Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics.
**Use your skills to make an impact**
**Required Qualifications**
+ AAPC CPC (Certified Professional Coder) Certification
+ 2 or more years of medical record review knowledge
+ 2 or more years of risk adjustment provider education
+ Familiar with coding guidelines (i.e. ICD-9/ICD-10)
+ Comprehensive knowledge of MS Word, Excel and PowerPoint
+ Analyzing Data to drive process improvement
+ Experience with public speaking and presentation skills
**Preferred Qualifications**
+ Bachelor's degree
+ Certified Risk Coder (CRC)
+ Experience interacting with healthcare providers
+ Ability to work independently
+ Medicare Risk Adjustment knowledge
+ Analyzing data to build unique education strategies in PowerBi
**Additional Information**
**Department Hours: 7am to 5pm EST**
Work at home - with ability to travel (up to 25% to surrounding provider offices)
**Additional Information**
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
**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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
\#LI-BB1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$71,100 - $97,800 per year
This 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$71.1k-97.8k yearly 24d ago
Associate Actuary, SPA-Rx
Humana 4.8
Hartford, CT job
**Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
_This a remote nationwide position_
The Associate Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. 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**
+ Bachelor's Degree
+ Associate of Society of Actuaries (ASA) designation
+ MAAA
+ Strong communication skills
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Prior Part D experience
+ Strong SAS skills
+ Prior Databricks experience
**Our Hiring Process**
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
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
**Alert:** Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website.
**_Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful._**
\#LI-Remote
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$106,900 - $147,000 per year
This 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.
Application Deadline: 01-29-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$106.9k-147k yearly Easy Apply 23d ago
Pharmacy Technician
Unitedhealth Group 4.6
Mansfield Center, CT job
"A Day in the Life" video (***************************** **Opportunities with Genoa Healthcare.** A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, medication management and more - are leading the way to a new level of care.
Genoa is a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Join us to start **Caring. Connecting. Growing together.**
We seek a **Pharmacy Technician** to support all functions of the Genoa mental health and specialty pharmacy primarily through dispensing medical prescriptions and performing necessary clerical duties while under the direct supervision of a Registered Pharmacist.
**Hours:** Monday - Friday 8:00am - 4:30pm (Lunch 12pm - 12:30pm)
**Location:** 140 North Frontage Road, Room 171, Mansfield Center, CT, 06250
**Primary Responsibilities:**
+ Provides exceptional customer service to all consumers and members of the clinic staff
+ Fills prescription orders and makes them available for verification under direct supervision of the Registered Pharmacist
+ Orders, receives and stores incoming pharmacy supplies
+ Receives and processes medication orders
+ Verifies medication stock and enters data in computer to maintain inventory records
+ Works with the Pharmacist to assist in the pharmacy functions and keeping the pharmacy in compliance with all federal and state requirements
+ Performs various clerical duties relating to the department
+ Communicates with strong professional verbal and written communication skills
+ Other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
**Required Qualifications:**
+ Active and unrestricted Pharmacy Technician license in the state of Connecticut
+ Access to reliable transportation and valid US driver's license
**Preferred Qualifications:**
+ 6+ months of Pharmacy Technician experience
+ National Pharmacy Technician Certification
+ Bilingual in English and Spanish
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
_At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._
_UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._
_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
\#RPO #RED
$16-27.7 hourly 13d ago
Business Intelligence Lead
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Business Intelligence Lead describes the tools, technologies, applications and practices used to collect, integrate, analyze, and present an organization's raw data to create insightful and actionable business information. This individual advises executives to develop functional strategies (often segment specific) on matters of significance. This individual exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action. We are seeking a detail-oriented and innovative professional to join our team and support a Medicaid reconciliation project focused on transforming premium capitation reconciliation processes. This role will play a critical part in modernizing methodologies, improving accuracy, and driving automation to ensure compliance and operational efficiency.
**Key Responsibilities:**
+ Lead initiatives to redesign and optimize premium capitation reconciliation processes
+ Collaborate with finance, operations, and IT teams to streamline data exchange and reporting
+ Analyze current workflows, identify gaps, and implement process improvements
+ Ensure compliance with regulatory requirements and internal controls
+ Develop tools and reporting solutions to enhance transparency and scalability
+ Support continuous improvement efforts to reduce manual intervention and improve timeliness
**Use your skills to make an impact**
**Required Qualifications**
+ Minimum 5 years of technical experience in Medicare and/or Medicaid data analysis
+ Minimum 3 years of project leadership or process improvement experience
+ Advanced experience in SQL, SAS, and/or other data systems
+ Experience with tools such as Tableau, Power BI for creating data visualization
+ Expertise in data mining, forecasting, simulation, and/or predictive modeling
+ Experience creating analytics solutions for various healthcare sectors
+ Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
+ Advanced experience working with big and complex data sets within large organizations
+ Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs
+ Proficiency in verbal/written communication to senior and executive leadership
**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**
+ Master's degree
+ Previous experience with Medicaid Premium Capitation Reconciliation
**Additional Information**
+ 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 HireVue. HireVue 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$117,600 - $161,700 per year
This 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$117.6k-161.7k yearly 2d ago
Provider Contracting Network Rep
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance.
Provider Contracting Professional 2
+ Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents
+ Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements.
+ Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.
+ Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally.
+ Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments.
+ Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives.
**Use your skills to make an impact**
**Required Qualifications**
+ 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts.
+ Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
+ Experience with public speaking and presentation skills
**Preferred Qualifications**
+ Bachelor's degree
+ Experience with ACO/Risk Contracting
+ Experience with Value Based Contracting
+ Excellent written and verbal communication skills
+ Ability to manage multiple priorities in a fast-paced environment
+ Proficiency in MS Office applications
**Additional Information**
+ Travel to Provider facing meetings as needed based on business needs
+ Hours- 8am to 5pm EST
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
**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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
\#LI-BB1
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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 - $88,600 per year
This 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.
Application Deadline: 01-14-2026
**About us**
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.
About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$65k-88.6k yearly 6d ago
Staff Utilization Management Clinical Pharmacist
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.
**_Earn a $5,000 hiring bonus!_** **Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment."**
**Location:** **Remote - United States**
**Schedule:**
+ 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST **OR**
+ 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST
+ Required to work **every 5th Saturday**
+ Required to work **1 company holiday per calendar year**
**Job Description:**
The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes.
**Use your skills to make an impact**
**Required Qualifications:**
+ **Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy**
+ Active pharmacist license in the state of residence
+ Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)
+ Self-directed with the ability to work effectively both independently and in a team environment
+ Strong problem-solving skills and the ability to foster collaborative solutions
+ High attention to detail with a strong work ethic focused on accuracy and productivity
+ Excellent verbal and written communication skills
+ Proficiency with computer systems, including but not limited to:
+ Microsoft Office Suite (Word, Excel, Outlook)
+ Clinical decision support tools (e.g., Micromedex, Lexicomp)
+ Pharmacy benefit management (PBM) platforms
+ Electronic health records (EHRs)
+ Passion for contributing to an organization focused on continuously improving the consumer experience
**Preferred Qualifications:**
+ Experience in managed care pharmacy, particularly in utilization management review
**Additional Information:**
**Interview Format** : 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.
**WAH Requirements:**
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 Statement:**
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 ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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.
$104,000 - $143,000 per year
This 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.
Application Deadline: 01-15-2026
**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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$41k-58k yearly est. Easy Apply 6d ago
Compliance Professional
Humana 4.8
Remote or Hartford, CT job
**Become a part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Compliance Professional who will ensure compliance with governmental requirements as they relate to Medicaid State reporting. The Compliance Professional's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Compliance Professional:
+ Manages state reporting for assigned Medicaid market(s) (contracts and gathering data for reports).
+ Researches compliance issues and recommends changes that assure compliance with contract obligations.
+ Maintains relationships with government agencies.
+ Coordinates implementation and compliance with corrective action plans as needed.
+ Begins to influence department's strategy.
+ Makes decisions on moderately complex to complex issues regarding technical approach for project components.
**Use your skills to make an impact**
**Required Qualifications**
+ **Must reside in the Eastern or Central time zones within the contiguous United States**
+ Bachelors degree or equivalent work experience (5+ years of healthcare, insurance, or financial services experience).
+ Two (2) or more years of compliance and/or health insurance experience.
+ Three (3) or more years of technical and computer navigation experience using multiple systems and platforms, specifically Excel, Word, PowerPoint and other Microsoft Office applications.
+ Experience managing multiple or competing priorities and meeting deadlines.
**Preferred Qualifications**
+ Analytical experience
+ Medicaid state reporting experience
+ Experience with ESP
+ Graduate degree
**Additional Information**
+ **Schedule:** Monday through Friday, 8:00 AM - 5:00 PM with flexibility to work overtime as needed.
+ **Work Location:** Eastern or Central time zones within the contiguous United States
+ **Work Style:** Remote
**Work at Home Internet Statement**
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 required; 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.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**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 - $88,600 per year
This 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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 ***************************************************************************
$65k-88.6k yearly 2d ago
Home Care Business Manager
Unitedhealth Group Inc. 4.6
Danbury, CT job
Explore opportunities with Patient Care, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.
The Home Health Business Manager is responsible for managing, coordinating, and directing the administrative support and non-clinical operations of the agency, and for ensuring that all duties are performed in a timely manner. The Business Manager is also responsible for ensuring that all administrative support to the Executive Director and/or Clinical Director functions are operating effectively and efficiently.
Primary Responsibilities:
* Overseeing and maintaining contracts, binders, and HR/medical files for all agency employees and contract staff in accordance with policy and applicable regulations
* Reviewing, reconciling, and submitting invoices to Home Office in accordance with LHC Group policy. This also includes ensuring payment is issued timely, following up on concerns, and maintaining a positive relationship with all vendors
* Performs and or manages billing audits per policy and follows-up with corrections
* Manages clerical staff and manages all non-clinical workflow and process in the office. This includes timely completion of all clerical tasks, as well as providing input into hiring, disciplinary, and separation decisions
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
* Must possess at least one of the following:
* 3+ years of healthcare experience
* 3+ years of experience in an office administration role
* Bachelor's Degree
* Computer proficiency, including Microsoft Office suite
Preferred Qualifications:
* Demonstrated solid organizational, written, verbal communication, and time management skills
* Demonstrated computer proficiency, including Microsoft Office suite
* Demonstrated ability to work independently
* Demonstrated solid process and people leadership abilities
* Experience with payroll process, supply management, and basic financial knowledge
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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