[Remote] Informatics Lead at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Utilization Management Experience
Proficiency in using technologies such as SQL and SAS
Strategic thinking and planning capabilities
Organized and detail-oriented
Experience in defining and executing measurement programs
Experience with advanced analytics, including program evaluation and optimization
Excellent verbal and written communication
Able to articulate and present findings and insights to senior leadership
Passionate about contributing to an organization focused on continuously improving consumer experiences
Master's degree and 4 or more years of technical experience (Preferred)
Pharmacy claim knowledge (Preferred)
Six Sigma certification (Preferred)
Advanced experience in SAS, SQL, Databricks, Python, QlikView, Power BI, Hadoop or similar tools (Preferred)

Responsibilities

Lead the design, implementation, and continuous improvement of forecasting models to project pharmacy prior authorization review volumes
Analyze historical and current data to identify key drivers and trends affecting HCPR workload
Integrate impacts from business initiatives, regulatory changes, and operational adjustments into forecasting
Collaborate with operational, clinical, and business partners to gather relevant inputs and communicate forecast outcomes and implications
Prepare and deliver clear, comprehensive reports and presentations on forecasting methodology, results, and variances for leadership and stakeholders
Document assumptions and methodologies in accordance with organizational policies
Uphold data integrity, transparency, and confidentiality consistent with applicable regulations and company policies

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.

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