Jobs at Humana

Supports Humana’s Product Security program by triaging and adjudicating vulnerability findings, assessing application security risks, and providing remediation guidance. Partners with engineering, architecture, and cybersecurity teams on secure SDLC practices, SAST, SCA, secrets detection, risk acceptance, and security exception workflows. The role also develops operational documentation, runbooks, and escalation processes while improving enterprise application security posture.

Lead end-to-end architecture and production operation of AI systems, including LLM clinical tools, RAG pipelines, agent workflows, and intelligent automation. Evaluate and fine-tune foundation models, build model and agent evaluation frameworks, and ensure safety, accuracy, clinical relevance, HIPAA compliance, and responsible AI governance. Partner with product, design, clinical, and data teams to translate care-delivery workflows into impactful AI features.

Lead cross-segment product strategy and solution architecture across Pharmacy, PCO, Home Solutions, and Humana Military. Own unified roadmaps, reference architectures, API and integration standards, and top-level product backlogs. Drive reuse, governance, compliance (HIPAA/PHI, ONC, DoD/TRICARE), and AI/LLM integration while enabling engineering delivery and executive decision-making.

Design and lead backend platform services, REST and GraphQL APIs, integrations, security patterns, HIPAA-compliant PHI controls, AI/LLM integration, observability, and reliability infrastructure. Contribute to end-to-end full-stack features using TypeScript, Next.js, and React. Establish architecture standards and reviews while supporting scalable services used by healthcare teams and patients.

Lead IT due diligence and end-to-end integration for M&A, divestitures, JVs, and investments. Develop integration strategies, Day 1 plans, budgets, risk mitigation, governance, and stakeholder communications across applications, infrastructure, cloud, cybersecurity, data, vendors, and IT teams to realize synergies and value.

Design, develop, secure, modernize, and support scalable omnichannel APIs for customer-facing web, mobile, contact center, partner, and enterprise applications. Improve API security, resiliency, performance, observability, testing, and reliability. Collaborate with architecture, security, cloud, product, operations, and engineering teams; lead technical delivery, mentor engineers, develop reusable patterns, and provide Tier 3 production support. Apply AI-assisted engineering practices and contribute to API lifecycle management and continuous improvement.

Configure, tune, and operate Microsoft Purview and Proofpoint ITM to detect and investigate insider threats. Triage alerts, reduce false positives, support eDiscovery, correlate telemetry with SIEM/EDR, automate policy deployment with KQL/PowerShell/Graph API, track KPIs, and ensure controls meet HIPAA/HITRUST/PCI-DSS/SOC2 requirements while partnering with Security Operations, HR, Legal, and compliance stakeholders.

Leads enterprise-scale, cross-functional programs and projects from feasibility through closeout, ensuring delivery on time, within budget, and aligned with business outcomes. Develops charters, plans, budgets, risk mitigations, stakeholder communications, and change-management activities. Facilitates meetings, oversees execution, manages quality and procurement, reports progress to executives, and supports organizational change. The role also applies project standards, ADKAR practices, and process-mapping tools in a remote shared-services environment.

Leads complex analytics initiatives and partners with business leaders to define problems, analyze pharmacy, sales, and operational data, and develop actionable recommendations. Manages engagements across the full analytics lifecycle, from discovery through solution delivery and implementation support. Designs metrics, dashboards, frameworks, and decision-support tools while communicating insights to executive, operational, and technical audiences. The role emphasizes consultative analytics and business problem solving rather than software development or data infrastructure engineering.

Develops and maintains end-to-end BI dashboards, reporting, and analytics solutions. Partners with leaders to define KPIs, optimize SQL and BI models, ensure data accuracy and governance, and support regulatory reporting. Uses healthcare data to deliver actionable insights, improve processes, and guide strategic decisions. Advises senior leadership through clear, data-driven communication while working with complex datasets and cross-functional teams.

Leads decision intelligence and agentic AI engineering across Humana’s NBA platform. Models business decisions, designs decision services and optimization strategies, and builds production AI workflows using LLMs, retrieval, tool calling, and orchestration frameworks. Oversees microservices, databases, policy engines, testing, observability, governance, and compliance. Partners with data science and business teams to operationalize reinforcement learning and improve member engagement. Leads and mentors a small engineering team while remaining hands-on.

Leads enterprise procurement strategy for contingent workforce, outsourcing, offshoring, consulting, and clinical services. Advises senior business leaders on operating models, sourcing decisions, business cases, commercial structures, negotiations, transitions, supplier performance, and value realization. Builds high-performing procurement teams and oversees complex services portfolios across Insurance and Corporate Services, balancing cost, quality, compliance, workforce agility, resiliency, and transformation outcomes.

Reviews clinical documentation to assess grievances, appeals, and additional requests; issues final determinations in collaboration with clinical and internal teams. Assigns cases for independent second-level review, tracks case distribution and volumes, maintains quality and productivity standards, and manages priorities in a fast-paced environment. The role is remote, requires occasional travel for training or meetings, and includes an 18-month department commitment.

Supports healthcare economics and value-based care initiatives through claims and revenue analysis, forecasting, financial reconciliation, performance measurement, and strategic insights. Develops scalable actuarial methodologies, reporting metrics, and analytical models; validates results and translates complex business requirements into end-to-end solutions. Partners with actuarial, finance, analytics, and business teams while working independently on complex and occasionally ambiguous assignments.

Manages Level 1 appeal cases by reviewing clinical documentation, validating determinations, coordinating with clinical and internal teams, and resolving member and provider issues. Ensures CMS compliance, confidentiality, accuracy, and timely case resolution while handling high-volume assignments in a production-driven environment. Requires flexibility for varied shifts, weekends, overtime, and occasional travel to Humana offices.

Leads actuarial risk and compliance activities for Medicare Advantage and prescription drug plan bid filings. Maintains and runs the CMS Out-of-Pocket Cost Model, interprets results, resolves compliance test failures, supports CMS audits, and develops filing controls and process improvements. The role assesses business risks, advises executives, reviews regulatory practices, and leads actuarial or support staff, including a direct report.

Analyzes and forecasts Medicare financial data, maintaining provider revenue and expense projection models and supporting tools. Integrates value-based provider impacts into financial and bid forecasts, develops risk modeling guidance, ensures data integrity, and establishes controls around data flows. Collaborates with stakeholders to resolve data anomalies through troubleshooting and root cause analysis. The role is remote, with occasional travel for training or meetings.

Manages a sales support team and enables field sales execution through strategic initiatives, sales operations, performance reporting, process standardization, and cross-functional collaboration. Oversees territory alignment, resource allocation, dashboards, forecasts, and data-driven improvements. Recruits, coaches, and develops direct reports while partnering with sales, marketing, compliance, training, analytics, HR, and external vendors. The role is remote with occasional travel to Humana offices for training or meetings.

Leads a team of provider engagement associates and develops strategies to strengthen relationships with contracted providers. Drives Medicare Advantage quality outcomes, Star Ratings, value-based care adoption, risk adjustment performance, and operational excellence. Uses claims, quality, utilization, and provider performance data to identify opportunities, advises leadership on market trends, represents the organization with provider partners, and ensures accurate performance tracking and reporting.

Senior clinical executive leading Utilization Management across Medicare and Medicaid. Sets UM clinical strategy, integrates physician and nursing review, oversees grievances/appeals, clinical contracting, vendor management, and dental review. Leverages analytics to improve Star Ratings, review consistency, and outcomes while developing clinical leadership and aligning UM with enterprise strategy.