Physicians Mutual Remote jobs - 44 jobs

**Become a part of our caring community and help us put health first** The Client Manager is responsible for growing membership within existing accounts and for directly managing business relationships with client accounts. The Client Manager work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **Job Responsibilities:** + Meets retention and growth objectives for assigned Professional Employer Organizations (PEOs) and Insurtech broker partners. + Acts as a strategic business partner to PEOs/ Insurtech partners for positioning Humana's ancillary solutions to their members, while meeting membership objectives. + Seeks opportunities to execute cross sell strategies by adding new Humana lines of business. + Conducts strategic planning alongside key stakeholders. Work collaboratively with various departments for recommendations to support the client's strategic goals. + Coordinates the renewal process, including the formal Request for Proposal process with internal partners: Underwriting, Corporate Proposal Team, Account Installation, Service, Humana Leadership team. This includes reviewing the proposal; leading the internal strategy call with the proposal team; developing proposal strategy; reviewing proposal responses; developing Executive Summary and timely submission. + Maintains the contractual obligations and reporting requirements, including Performance Guarantees and works with the Humana functional areas to provide the required data. Will also work with the regulatory, compliance and legal departments to complete and execute agreements. + In-depth analysis of reporting to consult clients with benefit and service solutions. + Main group contact for account installation, benefit plan changes, audits and special service requests, working alongside the service and customer service teams to meet client's expectations. + Works closely with dedicated internal teams for assigned clients- On Site representatives, Open Enrollment Hotline, Billing & Enrollment Single Point of Contact, or others to set and meet client expectations. + Represents Humana at community events, associations and industry organizations related to our organizational goals. + Liaison between assigned clients and Humana internal areas for escalated issues requiring special handling. + Leads the Open Enrollment discussion and strategy for assigned clients. Coordinates resources for client Open Enrollment, on site events and activities. + Co-creates custom communications alongside Marketing and the client for materials such as Open Enrollment materials, educational flyers, marketing events and onsite programs + Strong understanding of market dynamics, including competition, trends, influencers and history. **Use your skills to make an impact** **Job Requirements** + Bachelor's degree or equivalent experience + 5+ years' experience managing clients or selling within the Ancillary or Healthcare continuum + Understands the business model and regulatory and procurement requirements of PEOs. + Experience working with Insurtech partners or broker partners. + Consultative selling background and experience + Experience influencing C-suite Executives either directly or through a broker medium + Executive presence + Business and Financial Acumen + Strong communicator- written, verbal and presentation skills + Develops positive, collaborative client relationships + Active life and health license **Additional Information** **WAH Information** To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information \# LI-KR1 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. $93,400 - $127,300 per year This job is eligible for a commission incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 02-03-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. **Where you Come In** The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Use your skills to make an impact** **Required Qualifications - What it takes to Succeed** + High School Diploma or equivalent. + Minimum of two years' proven experience in processing and adjudicating medical claims, with a track record of accurate and timely claim review completion. + Proven ability to maintain confidentiality and handle sensitive information in compliance with organizational policies and applicable regulations. + Solid understanding of medical coding terminology, including CPT, ICD-9, and ICD-10 codes. + Proficient in Microsoft Office applications, specifically Word, Excel, and Outlook, to effectively manage documentation and communications. + Exceptional attention to detail and accuracy in reviewing and processing claims. + Ability to quickly adapt to and learn new systems and technologies relevant to claims processing. + Strong organizational skills with the capacity to manage and prioritize multiple tasks based on business needs. **Preferred Qualifications** + Associate or bachelor's Degree. + Previous experience with CAS claims systems. + Foundational knowledge of finance principles related to claims processing. **Additional Information - How we Value You** + Benefits starting day 1 of employment + Competitive 401k match + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave **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. **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 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. $44,900 - $60,200 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-28-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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. **Where you Come In** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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. As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will: + Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered + Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding + Utilize encoders and various coding resources + Perform CPT/HCPCS Procedure reviews + Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed + Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information + Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols + Complete appropriate system(s) entry regarding claim/encounter information + Support and participate in process and quality improvement initiatives **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Use your skills to make an impact** **WORK STYLE:** 100% work at home/remote **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, depending on business needs **Required Qualifications - What it takes to Succeed** + CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience + Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures + Strong knowledge of CPT/HCPCS coding + Experience reading & coding from operative reports + Chemotherapy/Therapeutic Infusion experience + Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information + Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities + Comfortable working in a production-based work environment + Ability to work independently and manage workload + Strong written and verbal communication skills; strong analytical, organizational and time management skills + Working knowledge of Microsoft Office Programs (Word, Excel) **Preferred Qualifications** + 5+ years prior coding experience + Minimum of 3 years post certification experience reading and interpreting claims + Outpatient facility auditing experience + Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology + Ambulatory Payment Classification (APC) coding experience + Radiation Oncology coding experience + Experience in prospective payment methodologies + Experience with the Claims Life Cycle including Accounts Receivable + 3M Coder software experience **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. $59,300 - $80,900 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: 01-30-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** You will report to Jordan McMurtrey and be a part of Innovative Financial Group (IFG) team. The Senior Sales Compensation Professional performs ongoing administration of calculating and paying sales commissions. The Senior Sales Compensation Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **Use your skills to make an impact** + Develop and maintain sales compensation plans, policies, and procedures to drive sales performance and align with business objectives. + Design and implement sales quota and territory management processes to ensure fair and equitable distribution of sales opportunities. + Analyze sales performance data to identify trends, opportunities, and challenges, and recommend adjustments to sales compensation plans. + Collaborate with cross-functional teams, including Sales, Finance, and HR, to ensure alignment and effective communication of sales compensation plans. + Ensure compliance with internal policies and external regulations related to sales compensation and incentives. **Use your skills to make an impact** **Required Qualifications** + 2+ years of experience in sales compensation design, administration, and analysis. + 2+ years' experience working with TSQL/SQL database + Strong understanding of sales compensation plan design principles, including quota management, territory alignment, and performance metrics. + Proficiency in sales performance analytics and data visualization tools, such as Tableau or Power BI. + Experience with sales compensation software, such as Varicent. **Preferred Qualifications** + Bachelors Degree + Certification in sales compensation, such as Certified Sales Compensation Professional (CSCP). **Social Security Task:** Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will 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. **Virtual Pre-Screen:** As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes. This is a remote position. 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: 02-12-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** We are seeking a Lead Product Designer to join our Identity & Access Management (IAM) product team. In this pivotal role, you will drive design excellence and user experience for our authentication, registration, profile/account creation, and account recovery flows-balancing seamless user experiences with robust security, transparency, and user control. You will collaborate closely with product managers, engineers, and other designers to translate complex technical requirements into intuitive, accessible, and secure user experiences. This position is ideal for a designer with a proven track record, seeking an opportunity to lead strategic design initiatives while remaining hands-on with craft and delivery. You will drive prioritization, planning, and decision-making across multiple product teams, while creating exceptional user-centered experiences that achieve business goals and exceed user expectations. The team is focused on integrating and developing best practices in usability, analytics, accessibility, and cross-platform strategy in an Agile development environment. **Key Responsibilities:** + Lead the end-to-end design process for IAM features and products, from discovery and user research through prototyping, testing, and final delivery + Serve as a primary point of contact with cross-functional partners in your workstream, ensuring alignment of UX deliverables + Work collaboratively with cross-functional teams to define user needs, business requirements, and technical constraints + Lead and execute strategic design initiatives that elevate product experiences and support organizational goals + Model exemplary design practices for the team-demonstrating rigor in research, design, file organization, prototyping, and presentation + Develop and lead workshops aimed at discovering hypotheses, exploring potential solutions, building enthusiasm, establishing shared understanding, and promoting team alignment + Foster a collaborative design culture by providing actionable feedback in weekly design critiques, mentoring peers, and delegating responsibilities on cross-team projects + Establish and maintain design systems and documentation for authentication, account management, and recovery workflows + Ensure that digital principles, standards, styles, design patterns, and renderings are followed and represented correctly + Partner with CX Insights to create long-term research strategies and facilitate ongoing discovery and iterative delivery + Partner with Content Strategy to continuously drive and improve content, navigation, and site architecture + Advocate for user privacy, security, and transparency throughout the product lifecycle **Key Competencies** _Big Picture Thinking_ + Ability to see the big picture and make good design decisions that may require trade-offs between business goals and design standards + Dedicated to envisioning and influencing the entire ecosystem to create a seamless, holistic experience for consumers + Ability to precisely articulate design rationale through a compelling narrative + Demonstrated ability to create designs that excite stakeholders just as much as users _Leadership_ + Ability to influence senior leaders, peers, and diverse teams consisting of a multitude of perspectives + Encourage creativity and risk-taking + Relentless advocacy for solutions that solve real user problems and remove barriers for our consumers _Professionalism_ + Have a strong professional presence, be approachable, respectful, open, transparent, and easy to work with - even in stressful, challenging situations + Be flexible - able to change course when needed + Have self-awareness, be comfortable receiving feedback, and work to continually improve + Make complex things simple, even when in white space and confronted with unclear situations + Possess excellent verbal, written, and presentation skills **Use your skills to make an impact** **Role Essentials** + 6+ years of experience in Product Design, with a proven track record in Identity & Access Management or related domains (authentication, registration, account creation, security flows) + Demonstrated experience of UX and interaction design methodologies, with a strong portfolio showcasing end-to-end IAM experiences + Understanding of security, privacy, and regulatory requirements impacting user identity + Ability to adapt existing processes and deliverables when necessary to meet project needs and improve efficiency and quality + Demonstrated ability to design complex transactional user interfaces and interactions + Excellent communication, presentation, and stakeholder management skills + Strategically adept with a penchant for curiosity + Understanding of accessibility standards and security principles + In-depth knowledge of performance metrics + Mastery of Figma **Role Desirables** + Experience in regulated environments such as Healthcare, Finance, etc. + Self-starter who can make significant progress with minimal guidance + Experience creating inclusive and accessible designs, particularly for senior adults + Ability to be flexible in a fluid and dynamic environment + Must be extremely well-organized and capable of handling multiple (and sometimes conflicting) priorities effectively + Familiarity with online usability testing platforms such as UserZoom or Usertesting.com + Excellent analytical and process-oriented skills + Excellent verbal, written and presentation skills **Virtual Pre-Screen** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first-round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text, and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews. **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. 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: 02-12-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Lead, Technical Product Owner requires someone known for creative problem solving. This role solves complex business problems and issues using data and custom software from internal and external sources. The role works on problems of diverse scope and complexity ranging from moderate to substantial. It is responsible for leading, defining and delivering on the roadmap of multiple data and business application products. This role bridges product ownership, data and software engineering, and regulatory healthcare data requirements, ensuring that data ingestion, transformation, and delivery are optimized for quality measurement, reporting, and compliance with CMS standards. We are seeking an individual with a growth mindset, who is a highly experienced Technical Product Owner to drive the development of data products specifically related to CMS Stars and HEDIS quality measures. The ideal candidate has deep expertise in Stars/HEDIS data, regulatory requirements, and agile product development, and 3 tier software development and technical support for critical systems. In this role, you will teach and collaborate with business stakeholders, data engineers, and IT teams to translate complex requirements into actionable product features that support quality measurement, reporting, and compliance. **Key responsibilities:** + **Technology strategy and roadmap of Business and Data Products:** Define and maintain the vision, strategy, and roadmap for data products that enable CMS Stars and HEDIS reporting. Ensure alignment with enterprise goals and departmental priorities. + **Backlog management:** Own, groom, and prioritize the product backlog for one or more agile teams, ensuring it reflects business needs, regulatory changes, and technical dependencies. + **Requirements translation:** Elicit detailed requirements from stakeholders (e.g., business, compliance, and analytics) and translate them into clear user stories with defined acceptance criteria for development teams. + **Cross-functional collaboration:** Act as the primary liaison between business stakeholders and technical teams. Facilitate communication and alignment across data engineering, analytics, compliance, and QA teams. + **Technical guidance:** Work closely with data architects and engineers to design and validate data flows, mappings, and transformations. Provide guidance to ensure technical solutions are feasible and aligned with the product vision. + **Data quality and compliance:** Collaborate with governance teams to establish data quality benchmarks and implement testing protocols. Ensure data products adhere to CMS mandates and NCQA standards. + **Technical debt management:** Advocate for the resolution of technical debt and architectural improvements, balancing short-term feature delivery with long-term product sustainability. + **Stay current:** Monitor evolving CMS, NCQA, and HEDIS requirements and coordinate necessary updates in response to specification changes. + **Travel for this role is quarterly** **Use your skills to make an impact** **Role Essentials** + Bachelor's degree + 8 or more years of experience in data flow & analysis and software application building & enhancements + 2 or more years of project leadership experience + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS measurement** + Familiarity with **CMS Stars programs** , NCQA standards, and quality performance metrics. + Advanced experience working with big and complex data sets within large organizations + Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction + Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs + Proficiency in understanding Healthcare related data + Proficiency in verbal/written communication to senior and executive leadership **Role Desirables** + Advanced Degree in a quantitative discipline, such as Mathematics, Economics, + Finance, Statistics, Computer Science, Engineering or related field + Knowledge of NCQA, CMS, and health plan quality measurement programs. + Deep understanding of healthcare interoperability standards (e.g., HL7, FHIR, X12). + Advanced in SQL, SAS and other data systems + Expertise in data mining, forecasting, simulation, and/or predictive modeling + Experience creating analytics solutions for various healthcare sectors **Additional Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is 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. 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 you. 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. $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. Application Deadline: 02-26-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** We are seeking a Lead Machine Learning Engineer to architect, develop, and manage machine learning systems that enable real-time, personalized decision-making across digital and assisted channels. These platforms leverage predictive modeling, optimization algorithms, and contextual data to identify the most relevant next action for each individual-at scale, with minimal latency, and with a strong emphasis on reliability and explainability. This position centers on production machine learning engineering. You will lead the creation of ML pipelines, online inference services, and decision-time scoring logic, utilizing AI-assisted and agentic solutions to enhance development velocity, model quality, and operational effectiveness. **Key Responsibilities** **ML System Design & Architecture** + Design and manage end-to-end machine learning systems, including: + Feature engineering and reuse strategies + Offline training pipelines + Online inference and scoring services + Model versioning, rollout, and rollback procedures + Ensure systems meet stringent requirements for latency, scalability, reliability, and correctness in real-time contexts. + Define clear separation between model development, deployment, and downstream decision logic. **Decision-Focused Modeling** + Build and operationalize models such as: + Propensity or likelihood prediction + Uplift or incremental impact models + Engagement or responsiveness scoring + Design models to be composable, explainable, and robust for automated decision workflows. + Collaborate with analytics and product teams to translate business objectives into measurable modeling outcomes. **AI-Enabled & Agentic Efficiency** + Apply AI-assisted and agentic approaches to boost ML engineering productivity, including: + Automated code generation and refactoring for pipelines and services + Feature exploration and validation + Intelligent experiment tracking and comparison + Enhanced debugging and root-cause analysis + Assess and adopt modern tools to accelerate experimentation, reduce manual overhead, and ensure reliable model operations. + Focus on implementing practical, production-ready AI tools. **MLOps & Model Operations** + Develop and sustain robust MLOps practices, including: + Continuous training and deployment pipelines + Online model monitoring for latency, drift, and stability + Safe rollout strategies (e.g., canary, shadow, phased releases) + Fallback mechanisms for model degradation or unavailability + Guarantee model outputs are traceable, reproducible, and auditable. **Collaboration & Leadership** + Serve as the technical leader for ML engineering, establishing standards and best practices. + Partner with software engineers, data engineers, and platform teams to ensure seamless integration of ML systems into production. + Mentor machine learning engineers and contribute to the overall maturity of engineering teams. + Influence architectural decisions to ensure testability, observability, and resilience. **Role Significance** As reliance on automated and intelligent decisions increases, the integrity of machine learning engineering becomes critical to organizational trust, performance, and user experience. This role ensures that machine learning systems are not only accurate but also reliable, interpretable, and efficient to develop and maintain. **Use your skills to make an impact** **Required Qualifications** + 8+ years of experience in machine learning engineering, applied ML, or data-driven platform development + 3+ years in a technical lead or senior ML engineering capacity + Deep expertise in: + Feature engineering and data pipelines + Model training and evaluation + Real-time or near-real-time inference systems + Strong software engineering skills in Python, Java, or similar languages + Practical experience with AI-assisted development tools to streamline ML workflows **Preferred Qualifications** + Experience with personalization, recommendation, or decisioning platforms + Familiarity with distributed systems and event-driven architectures + Experience deploying models in regulated or high-reliability settings + Knowledge of model explainability and fairness methodologies **Success Criteria** + Models deliver reliable performance in real-time decisioning workflows + ML systems scale effectively without excessive operational burden + Experimentation cycles are efficient, repeatable, and measurable + Engineering teams have confidence in model outputs and their transparency + AI-assisted tools drive measurable improvements in development speed and model quality **Additional 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. _WAH 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. $129,300 - $177,800 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: 03-19-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Director, Process Improvement provides direction and management to the claims processing vendor for claims reimbursements and operational activities to provide superior service to internal and external customers in support of the VA Community Care Network. The Director, Process Improvement coordinates with the Director, VA CCN Claims Oversight for alignment of accurate claims processing. Ensures a high level of quality in all areas while meeting or exceeding performance goals. **This position is created specifically to assist with Humana's efforts to secure and, if awarded, transition into a new business opportunity. Please note that continued employment in this role is expressly contingent upon Humana's receipt of the business opportunity and a satisfactory transition into the work. In the event Humana does not pursue the opportunity or determines that a timely and satisfactory transition cannot be achieved, employment may be subject to termination.** The Director of Claims Oversight will lead a dedicated team responsible to establish and maintain comprehensive oversight of the VA CCN payment invoicing process with a focus on vendor management and payment integrity. This role ensures timely reconciliation of VA payments, effective management of accounts receivable and recoupments, administration and oversight of X12 processes and files as well as coordination of banking and reporting activities. The Director will serve as a key liaison between internal stakeholders and claims vendors to optimize operational efficiency and compliance with regulatory standards. **Key Responsibilities:** + Oversee claims processing activities performed by external vendors, ensuring accuracy, timeliness, and compliance with contractual and regulatory requirements. + Monitor and review claims payment processes, identifying opportunities for process improvement and risk mitigation. + Direct the reconciliation of claims payments, maintaining detailed records and ensuring resolution of discrepancies. + Manage accounts receivable and recoupment processes, coordinating with finance and provider relations teams to ensure timely recovery and reporting. + Lead banking coordination and reporting activities, working closely with finance to maintain transparency and accuracy in financial transactions related to claims. **Use your skills to make an impact** **Required Qualifications** + Our Department of Defense contract requires U.S. Citizenship for this role + Must successfully receive interim approval for government security clearance (NBIS- National Background Investigation Services) + HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. + Bachelor's degree in Accounting, Finance, Business, Health Care Administration, Government Contract Management, or Operations Management or if non-degree, must have at least 5 years of experience with TRICARE and/or VA CCN in claims or financial transaction area. + 5 years of experience in a managed care environment and financial transactions and claims area + Experience with VA, TRICARE contracts and/or the military health care delivery system, and/or Medicare reimbursement + Experience with data analysis and making decisions using data **Work at Home Requirements** To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone 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. $150,000 - $206,300 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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist (VSP/PT) 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. **Location:** **Remote - United States** **Schedule: This is a VSP (Variable Service Provider) role. The hours will vary between 24-40 hours per week.** **The s** **hift for training will be 10:00AM-630PM ET.** **After training, a shift of either 11:00AM-730PM ET, 12:00PM-830PM, or 1:00PM-930PM will be assigned based on business need.** **Some weekend coverage may be required. Mandatory overtime during peak season.** **Job Description:** The Staff Utilization Management Pharmacist (VSP/PT) 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 **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** 1 **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 **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. Application Deadline: 01-30-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** Are you ready to make a tangible impact at the intersection of technology and business operations? In this pivotal role, you'll work with talented teams and serve as the technical liaison for BPO operations, influencing Major Incident, Problem, and Change Management functions across the organization. Your expertise will be valued as you collaborate with technical and non-technical stakeholders, drive resolution of moderately complex issues, and help minimize business disruption. This is your opportunity to showcase advanced skills in networking, telecom, and application support while building lasting partnerships across internal and external teams. Join us and shape the future of operational excellence through your leadership and technical acumen. The Senior Technology Leadership Professional works with internal and external technical stakeholders to expedite restoration of major incidents, conduct problem reviews, and oversee change reviews. Works with a team to ensure timely and efficient operational activities. Provides technical guidance and makes decisions to resolve moderately complex issues. Advises leaders on technical trends and operational improvements to reduce IUMs. Exercises independent judgment requiring analysis of variable factors and determining best courses of action under minimal supervision. + **Required Qualifications** + 5 or more years of technical experience + Experience managing major incident outage bridges + Strong technical knowledge across networking, telecom, and application support + Ability to manage multiple priorities and deadlines with attention to detail + Proven ability to communicate effectively + Experience producing metrics, measurements, and trend reports + Passion for driving continuous improvement in consumer experience + **Preferred Qualifications** + Bachelor's degree or higher + Demonstrated ability in large-scale, highly visible programs + Solid understanding of operations, technology, and processes + ITIL certification + Six Sigma certification **Use your skills to make an impact** **Why Humana?** **You'll experience the following perks as a full-time Humana employee:** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **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. **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. \#LI-Remote **Social Security Task** 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. $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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. 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** + 3 or more years of progressive network management experience + Experienced in negotiating managed care contracts + Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures, and reimbursement rates to providers. + Excellent written and verbal communication skills + Ability to manage multiple priorities in a fast-paced environment + Proficiency in MS Office applications **Preferred Qualifications** + Bachelor's degree + Experience with ACO/Risk Contracting + Experience with Value Based Contracting **Additional Information** This role is "remote/work at home", however, you must live/work in the Eastern or Central Time Zone. **Work at Home Information** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is 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. $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: 01-29-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Required Qualifications** + MD or DO degree + 2 or more years of project leadership experience + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience post residency + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc. + Internal Medicine, Family Practice, Geriatrics, and Hospitalist clinical specialists **Additional Information** + The Corporate Medical Director will conduct clinical case reviews of the care received by members in an assigned market, member population, or condition type. Though the Corporate Medical Director may serve as an expert in a particular condition or functional area, they do not typically spend time engaging in case reviews directly. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information This is a remote position \#LI-Remote 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. $246,100 - $344,200 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: 04-15-2026 **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 ***************************************************************************

**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 building advanced agentic systems capable of autonomously managing and decomposing complex goals. We are seeking an expert in agent design, planning, and control to develop and evaluate agents that can set, adapt, and execute goals in dynamic, real-world environments. You'll contribute to the scientific and engineering foundations that make AI agents reliable, interpretable, and robust across long-horizon tasks. **Key** **R** **esponsibilities** + Architect goal setting and goal decomposition mechanisms for autonomous agents operating in uncertain or open-ended environments + Design and implement dynamic planning systems (e.g., hierarchical planning, curriculum learning, scratchpad/self-refinement loops) + Collaborate on memory, tool-use, and feedback-loop designs enabling multi-step, self-directed agent behavior + Develop evaluation frameworks for alignment with human intent, consistency, progress against long-horizon objectives + Prototype agents that interface with APIs, MCP servers, search engines, databases, or real-world actuators to pursue goals safely and efficiency + Explore mechanisms to detect and mitigate goal misalignment, looping behavior, or undesirable emergent strategies + Work across teams to integrate goal alignment with safety, alignment, and operational reliability mechanisms **Technical skills** + Proficiency in SQL, Python, and data analysis/data mining tools. + Experience with machine learning frameworks like Pytorch, Jax, LangChain, LangGraph or AutoGen + Experience with high performance, large-scale ML systems + Experience with language modeling with transformers + Experience with symbolic planning, causal reasoning, and model-based RL + 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 **Preferred Qualifications** + Ph.D. in Computer Science, Data Science, Machine Learning, or a related field + Demonstrated experience shipping autonomous, or semi-autonomous agents in production or simulation + Experience with LLM-based agents with scratchpad/self-reflection or hierarchical task decomposition + Understanding of autonomy risk mitigation strategies, including off-switch protocols, or bounded rationality **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 ***************************************************************************

**Become a part of our caring community and help us put health first** TThe Senior Financial Planning and Analysis Professional collects, compiles and is responsible for analyzing multiple sources of data to identify emerging trends or gaps in expectations of the financial performance for the WI Medicaid segment. Analyses will help define efforts to mitigate claims costs or optimize top line revenue, working in partnership with key functional areas such as clinical, provider development, and operations. The Senior Financial Planning and Analysis Professional work assignments involve moderately complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. This work may involve financial modeling and reporting and may support inputs used in the financial budget and forecasting models. Begins to influence department's strategy. Makes decisions on moderately complex issues regarding technical approach for project components, and work is performed with minimal direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree in Finance, Accounting or a related field + 5 or more years experience in finance/accounting or related field + Comprehensive knowledge of all Microsoft Office applications, and Access, SQL, and multi-dimensional databases + Ability to manage multiple priorities + Experience with financial analysis + Strong analytic skills with attention to details + Excellent oral and written communication skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences and growth in the market **Preferred Qualifications** + Master's Degree in Business Administration or a related field + Previous health insurance industry experience + Experience with SAS or other relational databases + Experience working with large data sets + Medicaid or Medicare experience **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 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. $86,300 - $118,700 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: 01-30-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Senior Business Intelligence (BI) Engineer engages with business value streams on diverse and complex opportunities leveraging a variety of technology platforms. The individual will deliver on requirements using data from various sources to provide insights to decision-makers and enhanced process automations with minimal direction. The Senior Business Intelligence (BI) Engineer leverages the technologies and industry best-practices to collect, integrate, refine, and present organizational data to facilitate improved business decisions based on business value stream requirements. The Senior BI also seeks out new concepts which may benefit departmental strategy. Additionally, the individual should be a self-starter who will make decisions on complex and diverse opportunities regarding technical approach for project components with minimal direction. Must possess a passion for continuous learning and building professional relationships. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree and 4+ years of professional experience with data and process automations **-OR-** + Master's degree and 2+ years of professional experience with data and process automations + Experience analyzing data to address a wide variety of business opportunities and create data visualizations that drive strategic direction + Comprehensive knowledge of Microsoft 365 applications including Word, Excel, and PowerPoint + Proficiency in verbal and written communication to senior and executive leadership + Demonstrated passion for contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Advanced Degree and/or Technical Certifications such as Microsoft's PL300, Databricks, SQL, and/or Python + 2+ years of experience with SQL, Python, SaaS and/or data querying languages/systems + 2+ years of experience with Microsoft Power Platform application suite, particularly Power BI and/or Power Apps/Automate + Experience in data mining, predictive modeling, and/or trend analysis techniques + Experience creating analytics solutions for various healthcare sectors **Additional Information** **This role is not eligible for work visa sponsorship.** 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. 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. 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. $89,000 - $121,400 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: 01-26-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. **The first 4 weeks of training will be from 8:30AM to 5:00PM EST. No time off is permitted during the first month of training. Following training, the start time is 10:00AM -6:30PM EST.** Our nurses are titled Care Managers, because our case management services are centered on the person rather than the condition. We contact members with multiple chronic conditions as well as financial and functional barriers in order to assist them in achieving and maintaining optimum health. We provide telephonic outreach to assess and support their health, offering education, identifying resources, and helping remove barriers to achieving health and independence, while using a multidisciplinary team. **This position will be part of our Special Needs Program (SNP) team** . All of our SNP RN Care Managers are work at home associates, working from a dedicated home office space. Work at home care managers are responsible for meeting quality and productivity measures daily and maintaining working home internet at all times with demonstrated advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system. Environment is fast paced and requires ability to engage quickly with member while concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare, Medicaid, and/or and Group Account members and create actionable and measurable care plans to help guide and track the members' progress toward goals + Use nursing judgment to assess and coordinate care for acute situations (APS, EMS) + Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc. + Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members + Assess member's physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team, such as social workers, dietitians, pharmacists, etc., employing a variety of strategies/techniques to manage appropriately and provide timely intervention **Use your skills to make an impact** **Required Qualifications** + Active Registered Nurse (R.N.) license with no disciplinary action. + **Hold an active Compact nursing license and reside in the state that holds your compact license.** + The National Council of State Boards of Nursing (NCSBN) developed the Nursing Licensure Compact (NLC), which is an agreement between states that allows nurses to have one license and the ability to practice in all the states that participate in the program. License must be current with no disciplinary action. + **Must be bilingual in Spanish and Engligh - resume must be submitted in English** + **Oral and written fluency in Spanish and English** - ability to pass a language test will be required. + Minimum of an Associate's degree in Nursing + Seasoned RN with a **minimum of 3 years of clinical nursing experience.** + Demonstrated clinical knowledge and expertise as evidenced by providing intervention to manage variety chronic conditions, including development and implementation of individualized care planning. + Intermediate to advanced computer skills as evidenced by ability to navigate multiple systems, utilizing dual computer monitors. + Provide autonomous decision-making, troubleshooting and problem solving related to periodic system issues. + Experience with Microsoft and Excel + Ability to quickly learn and navigate software programs and applications. + Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously. + Effective communication and interpersonal skills. + Effective problem solving and appropriate application of clinical knowledge + Must have a separate room with a locked door that can be used as a home-office to ensure you and your members have absolute and continuous privacy while you work. + Must possess advanced telephonic and virtual communication skills. **Preferred Qualifications** + BSN or MSN degree in nursing or equivalent + Previous adult chronic conditions care management + Previous experience in care management including knowledge of complex care management and care management principles + Experience with motivational interviewing + Experience with MCG or CMS guidelines, assessment and documentation practice + Case Management certification (CCM) **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. $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: 03-26-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Lead Actuary will be responsible for Medicaid functions such as forecasting market-specific financial results, capitation rate review, drafting rate advocacy communications, actual-to-expected business analytics, and many ad hoc analyses. They will advise market leadership and executives to develop rate advocacy and operational strategies which will have a significant financial impact on the business. They will work closely with the Director to ensure key workstreams are meeting timelines and that work is properly balanced among team members. The Lead Actuary will exercise independent judgment and decision making on complex issues and works under minimal supervision. They will also be responsible for developing and communicating team best practices such as peer review and documentation. **Use your skills to make an impact** + Required Qualifications + FSA, MAAA or ASA, MAAA plus relevant advanced degree + Bachelor's Degree + At least 8 years of relevant work experience + Strong written and oral communication skills + Ability to manage several workstreams and prioritize competing interests + Passionate about contributing to a growing Medicaid team + Preferred Qualifications + 3 years of experience within the managed Medicaid industry + In depth knowledge of capitation rate development and the associated regulatory environment + Track record of communicating complex actuarial concepts to a non-actuarial audience + Additional information + Fully remote role within the US + Minimal travel - up to 4 times per year (2-3 days each) 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. $129,300 - $177,800 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: 02-27-2026 **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 ***************************************************************************

**Become a part of our caring community and help us put health first** We are seeking a highly skilled and experienced Senior Systems Engineer to join our IT Infrastructure team, specializing in Linux server patching and maintenance. The ideal candidate will have a strong background in enterprise Linux environments, systems administration, automation, and security best practices. This role is critical to ensure the stability, security, and compliance of our Linux server infrastructure. The Senior Systems Engineer develops and/or modifies systems software for use internally, conducts requirements gathering and analysis, writes code using lower-level assembly languages and/or higher-level languages (e.g., C) and translates/compiles into machine language for use on specific hardware, and supports software testing, deployment, and maintenance activities by correcting programming errors and coding software 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** **Key Responsibilities:** + Plan, schedule, and execute patching of Linux servers (Red Hat, Oracle Linux, etc.) in accordance with organizational policies and regulatory requirements. + Assess, test, and validate patches and updates in non-production environments prior to deployment. + Coordinate with application owners and other stakeholders to minimize downtime and business disruption during patching activities. + Monitor server health, performance, and security post-patching; address issues as needed. + Automate patch management processes using tools such as Ansible, or Satellite. + Maintain accurate documentation of patching activities, compliance status, and server configurations. + Participate in vulnerability management efforts by remediating security findings related to Linux systems. + Collaborate with cross-functional teams to support operational excellence and incident response + Continuously improve patching procedures and policies based on industry's best practices and emerging threats. **Required Qualifications:** + Bachelor's degree in Computer Science, Information Technology, or related field, or equivalent experience. + Minimum 5 years of experience in Linux systems engineering/administration in a large-scale enterprise environment. + Demonstrated expertise in patch management, system upgrades, and vulnerability remediation for Linux servers. + Experience with automation tools (e.g., Ansible ) and scripting (e.g., Bash, Python). + Excellent troubleshooting, analytical, and communication skills. + Ability to work independently and as part of a team in a dynamic, fast-paced environment. + Experience with cloud-based Linux environments (AWS, Azure). 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. 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 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 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. $97,900 - $133,500 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 ***************************************************************************

**Become a part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicare provider reimbursement methodologies. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible for maintenance and support of Medicare outpatient provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, claims operations, and other business teams involved in the administration of Medicare business at Humana. The Senior Business Intelligence Engineer will develop and maintain expertise in complex Medicare reimbursement methodologies. This role is within the Integrated Pricing Solutions (IPS) department which falls under the Provider Process and Network Organization (PPNO). **The Sr. Provider Hospital Reimbursement Analyst will be responsible for:** + Researching and maintaining expertise in Medicare Outpatient Prospective Payment System reimbursement methodologies (OPPS, ASC, FQHC, etc.) + Demonstrating expertise in Medicare Integrated Outpatient Code Editor (I/OCE) logic (i.e. grouping rules, OCE data files, editing, etc.) + Analyzing and interpreting CMS Regulatory documentation for Medicare Prospective Payment Systems (i.e. final and proposed rules, transmittals, manuals, legislation, etc.) + Supporting implementation of Medicare pricer projects and enhancements including but not limited to: + Reviewing pricing software vendor specifications. + Identifying system changes needed to accommodate CMS logic. + Assisting with requirements development. + Creating and executing comprehensive test plans + Ongoing Medicare Pricer maintenance, quality assurance, and compliance + Determine root causes driving issues and developing solutions + Working closely with IT and pricing software vendor to resolve issues + Utilize data and expertise to identify automation and improvement opportunities + Research and resolve complex provider reimbursement inquiries and advise operational teams on Pricer edit resolution + Provide consultation to internal business partners on Medicare reimbursement/editing logic and Humana system logic **Use your skills to make an impact** **Work-At-Home Requirements** + WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + 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. $89,000 - $121,400 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 ***************************************************************************