Principal, Stars Enterprise Activation – Insurance Operations at Humana

Louisville, Kentucky, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor’s degree
8-9+ years of quality improvement, developing & advancing enterprise strategy, insurance operations experience (e.g., claims, UM, CM, call center, enrollment)
5 years of CMS Stars program experience
Medicare Advantage experience
Previous leadership experience as a people leader, leading through influence, or leading complex projects with engagement from multiple areas

Responsibilities

Oversight of related budget, vendor relationships, and program/project management
Serve as the primary liaison for Stars initiatives within Insurance Operations, building deep operational knowledge of core functional areas (care coordination, quality, billing, claims, and customer service)
Collaborate with each Insurance Operations function to identify, understand, and align Stars-related business strategies, objectives, and operational requirements
Evaluate business processes across Insurance Operations to identify synergies, integration opportunities, and operational risks related to Stars performance and compliance
Coordinate with analytics and reporting teams to generate actionable insights, enabling data-driven prioritization of operational improvements that directly impact Stars measures
Partner with segment and enterprise Stars leaders to advance cross-functional initiatives, ensuring alignment between operational execution and Stars strategy
Maintain a comprehensive inventory of Stars initiatives within Insurance Operations, identifying gaps and facilitating collaboration to maximize impact across all operational areas
Lead and support the design, implementation, and optimization of Stars-related programs and processes within Insurance Operations, including performance monitoring and continuous improvement
Oversee test-and-learn pilots to validate solutions and measure operational effectiveness, using results to inform broader implementation
Develop and deliver regular reports on Stars operational performance to executive leadership, providing clear visibility into progress, challenges, and opportunities
Manage budgets, vendor relationships, and project plans to support the successful delivery of Stars-focused operational initiatives

Skills

Medicare Stars

Medicaid Stars

Program Management

Project Management

Vendor Management

Budget Oversight

Care Coordination

Quality Measurement

Claims Processing

Customer Service

Strategic Planning

Risk Management

Cross-functional Collaboration

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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