[Remote] Actuary, Medicaid Trend Analytics and Data Management at Humana

San Antonio, Texas, United States

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's Degree in Actuarial Science or related field
FSA or ASA degree plus relevant advanced degree
Recent and relevant work experience
Strong communication skills
Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Experience in managing large healthcare claim datasets and conducting trend analysis
Deep understanding of healthcare claims taxonomy (service categories, such as LTSS)
Advanced knowledge of Databricks, SQL, or Python
Ability to translate complex data into actionable insights
Effective communication skills for technical and non-technical audiences
Demonstrated project management skills with ability to drive work independently and effectively lead through collaboration
Skilled in gathering customer input and translating it into clear business requirements
Proficient with data visualization tools, such as Power BI and Tableau
Working knowledge of designing dashboards to support business insight
Travel: occasional travel to Humana's offices for training or meetings

Responsibilities

Design and maintain Medicaid claims analytics dataset using Databricks
Conduct in-depth analysis of healthcare claims utilizing revenue codes, CPT/HCPCS, ICD-10 diagnosis codes, DRG, etc
Partner with actuarial, financial, and clinical teams to align on data definitions, methodologies, and reporting
Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data
Maintain dashboards to communicate key trends to stakeholders
Collaborate with stakeholders to understand business needs/issues, troubleshoot problems, conduct root cause analysis, and develop cost effective resolutions for data anomalies
Develop and execute necessary processes and controls around the flow of data
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
Analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions
Establish metrics, provides data analyses, and works directly to support business intelligence
Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position
Works on problems of diverse scope and complexity ranging from moderate to substantial

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI

Try Jobo Free