[Remote] Value Based Programs Business Intelligence Lead at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

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

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's degree
Minimum 8 years of technical experience in data analysis or Master’s degree and 4 years of experience
2 or more years of project leadership experience
Advanced experience working with big and complex data sets with large organizations
Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs
Proficiency in understanding Healthcare related data
Proficiency in verbal and written communication to senior and executive leadership
Strong organizational skills

Responsibilities

Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care
Design and develop data models to attribute members to providers and evaluate program effectiveness for new value-based programs
Design and develop value-based programs to scale while compensating for differences between each market
Model development and report creation of provider performance and reconciliation based on contractual terms
Analyze utilization data to reconcile provider disputes
Design and develop provider reporting packages to help providers understand their overall performance
Partner with finance team to conduct impact analysis and modeling for new VBP models
Collaborate with cross-functional and matrixed teams to operationalize and roll out new VBP models
Develop and monitor VBP model performance key performance indicators (KPIs) to identify opportunities to enhance model design based on internal and external feedback and performance data
Design and develop Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, STARS etc
Ensure data integrity in program administration for all value-based programs
Troubleshoot data integrity issues and offer solutions to solve challenges

Skills

Key technologies and capabilities for this role

Business IntelligenceData ModelingData VisualizationSQLAnalyticsData AnalysisHealthcare DataFinancial AnalysisUtilization AnalysisPerformance Metrics

Questions & Answers

Common questions about this position

What is the employment type for this position?

This is a full-time position.

What are the key responsibilities of the Value Based Programs Business Intelligence Lead?

Key responsibilities include analyzing financial, utilization, and performance data; designing data models for member-to-provider attribution and program effectiveness; developing provider reporting packages; partnering with finance on impact analysis; and collaborating with cross-functional teams to roll out new VBP models.

What skills and expertise are needed for this role?

The role requires expertise in data modeling, business intelligence tools for collecting, integrating, analyzing, and presenting data, independent judgment on complex issues, and skills in financial/utilization analysis, ROI modeling, and KPI monitoring.

What is the company culture like at Humana?

Humana fosters a caring community focused on putting health first, is recognized as a Fortune Top Company and one of the Best Places to Work, and offers a dynamic team environment for driving change through analytics.

What makes a strong candidate for this Business Intelligence Lead role?

Strong candidates are passionate about driving change through analytics, have experience solving complex business problems with data from internal and external sources, can exercise independent judgment under minimal supervision, and excel in strategic decision-making for data modeling and visualization.

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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