Jobs at Humana

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.

Lead architecture for CenterWell programs, define reference architectures, govern solution designs, enable AI/ML (agentic) integrations across cloud/data platforms, ensure compliance and delivery readiness, and collaborate with product, engineering, security, and executive stakeholders.

Provides executive administrative support to four senior leaders, including complex calendar management, travel planning, meeting logistics, leadership events, presentations, communications, expense management, and administrative processes. The role requires strong organization, discretion, communication, judgment, and relationship-building while supporting a large technology and data organization. The employee must be based in the Boston area and work in-office regularly during standard business hours.

Define strategy and drive delivery for a portfolio of enterprise AI products. Responsibilities include business discovery, AI prototyping, requirements, product execution, evaluation frameworks, solution architecture, governance, responsible AI, executive communication, and cross-functional leadership. The role establishes reusable AI standards, playbooks, and solution patterns while mentoring product leaders and guiding products from concept through production.

Lead development of AI products from discovery through production: define strategy and roadmap, prototype with agentic tools, translate business problems into scoped AI use cases, own requirements and delivery, design evaluation and quality metrics, support solution architecture, lead cross-functional teams, navigate enterprise AI governance, and mentor product managers.

Lead product strategy, backlog management, and platform development for Adobe Experience Platform web integrations across authenticated and unauthenticated channels. Translate business, regulatory, and customer needs into product requirements while partnering with engineering, architecture, marketing, CRM, legal, privacy, and compliance teams. Drive consent, preference, identity, personalization, and downstream activation capabilities; support enterprise adoption; monitor KPIs, data quality, integration health, and compliance risk; and optimize customer experiences across digital and omnichannel platforms.

Manages provider data, audits, relations, credentialing, contract systems, and service-failure processes for health plans. Coordinates administrative workgroups and external vendors, prioritizes daily activities, monitors schedules and goals, and oversees key processes with limited supervision. Requires provider relations or healthcare experience, project management experience, and intermediate Microsoft Office skills. This is a remote role aligned to Central Time with occasional travel.

Sets pricing assumptions and develops Medicare Part D bid pricing models. Analyzes claims, drug utilization, member behavior, market dynamics, drug launches, regulatory changes, and clinical developments to forecast pharmacy costs. Maintains pricing tools and utilization projections, researches cost trends, collaborates with pricing, clinical, pharmacy, formulary, and finance teams, and communicates recommendations to leadership.

Leads contract management, compliance, subcontract administration, procurement oversight, and ethics functions across Federal Government programs. Provides strategic direction and operational oversight to ensure contracts, purchasing, small business commitments, and compliance activities meet FAR, DFARS, regulatory, and organizational requirements.

Review utilization management activities and documentation to ensure policy and regulatory compliance. Collect and analyze outcome and operational metrics, process QIO fast-track appeals and expedited authorizations, make independent determinations, and follow regulatory turnaround times. Work a four-day, 10-hour shift schedule (Wed–Sun or Thu–Sun) in an EST-operating, remote role with strict home-office and internet requirements.

Leads Humana’s enterprise conversational channels and advocate experience portfolio, including IVR, routing, conversational AI, virtual assistants, co-browse, intelligent search, and CRM. Owns product strategy, roadmaps, UX, architecture, delivery, modernization, and outcome measurement across member and advocate journeys. Partners with operations, technology, analytics, and digital teams to improve service quality, productivity, authentication, routing, efficiency, and member outcomes. Requires extensive leadership in product management, contact center technology, enterprise AI, regulated environments, and cross-functional portfolio delivery.

Leads Humana’s enterprise digital platform portfolio, defining multi-year product strategy, investment priorities, adoption plans, governance, and value-realization metrics. Oversees platforms including Adobe Experience Platform, consent management, digital health, design systems, content, and reusable digital services. Partners with business, design, technology, and engineering leaders to align roadmaps, drive enterprise adoption, manage trade-offs, and improve customer and business outcomes. Develops senior product leaders and cross-functional teams in a regulated environment.

Develops and executes Medicare Advantage pricing strategies, establishes assumptions, prepares bids, supports regulatory filings and certifications, implements rates and benefit changes, and advises product leaders. Analyzes market performance, forecasts, competitive conditions, and experience data to recommend pricing actions supporting profitability and membership growth. Requires cross-functional collaboration, actuarial judgment, and compliance with state and federal regulations.

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.

Provide non-clinical administrative support for utilization management by following established policies and processes. Complete clerical tasks, maintain accurate records, meet productivity and quality standards, prioritize work, escalate issues beyond guidelines, and collaborate with internal teams. Work is performed under close supervision to support appropriate member care and efficient operational workflows.

Supports internal audit projects and consulting engagements as a clinical subject matter expert. Reviews clinical documentation, workflows, controls, and quality activities to identify risks and assess regulatory compliance and operational effectiveness. Prepares audit reports, presents findings to management, and recommends process improvements. Requires an active RN license and experience in clinical nursing, care management, utilization management, population health, healthcare operations, or related compliance activities.

Supports corporate accounting operations, including month-end close, journal entries, reconciliations, intercompany transactions, eliminations, mergers and acquisitions, financial reporting, and internal controls. Reviews offshore accounting work, analyzes complex accounting issues, performs ad hoc financial analysis, and contributes to process improvement projects. Requires strong U.S. GAAP knowledge, sound judgment, and cross-functional collaboration.

Performs medical necessity and comprehensive medication reviews for pre-authorizations, analyzes medication care plans and utilization patterns, advises patients/providers to promote cost-effective, quality outcomes, and follows established utilization management guidelines.