Community Engagement Manager in United States

Become a part of our caring community The Consumer Experience Lead ensures optimized interaction between a company and members. The Consumer Experience Lead works on the remediation of identified issues from the Resolution team root cause hub to resolve member abrasion points on a diverse scope. You will report to the Director, Strategy Advancement. As the Consumer Experience Lead you will Lead strategic and operational initiatives that improve business performance, organizational effectiveness, and cross-functional execution Analyze complex issues to identify root causes, uncover improvement opportunities, and recommend sustainable solutions. Build relationships, influence decision-making at all levels, and communicate recommendations Manage escalations, resolve issues, and accountability for commitments, deliverables, and action items across teams Strengthen operations through documentation, strategies, self-service resources, process optimization, and decision-support materials for leadership Use your skills to make an impact Required Qualifications Bachelor's degree 3 or more years of experience in Healthcare operations 3 or more years of project management experience 3 or more years of project leadership experience Demonstrated analytical with experience identifying root cause and implementing sustainable solutions Live in EST or CST time zone Preferred Qualifications Experience supporting executive leadership teams or enterprise-wide strategic initiatives Experience with operation excellence, process improvement methodologies, or business transformation efforts Demonstrated Executive leadership experience with communication strategy skills <p style="text-align:inheri

Become a part of our caring community Services represent one of the organization’s most consequential sources of capability, capacity, transformation and external spend. The Associate Vice President, Services Procurement will lead the enterprise strategy for contingent workforce, outsourcing and offshoring, consulting and clinical services, converting third-party services into measurable business outcomes, workforce agility, operating leverage and sustainable value. The AVP will serve as the senior Procurement partner to leaders across the Insurance segment and Corporate Services, helping shape operating-model, workforce and transformation decisions before sourcing begins or a supplier solution is selected. The leader will bring deep expertise in global business services, business process outsourcing, workforce solutions and complex professional services. The mandate is to strengthen business-case quality, establish clear make, buy, build, automate and partner choices, create fit-for-purpose commercial models, manage transitions and hold providers accountable for committed outcomes. Success will be measured by whether business leaders make better services and workforce decisions, transformations deliver their promised value, and suppliers improve performance and innovation. Key Responsibilities Serve as the Strategic Services Partner to Business Leaders Serve as the senior Procurement relationship leader and trusted commercial advisor to Insurance segment and Corporate Services leadership. Develop a deep understanding of business strategy, operating plans, transformation roadmaps, workforce needs and financial commitments, and translate them into integrated services, workforce and supplier strategies. Engage upstream of supplier selection to frame the problem, test demand and assess make, buy, build, automate, offshore, outsource

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1&#43; year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi

Become a part of our caring community As a Care Management Support Assistant, you will help members take the next step toward better health and well-being. You will do this by connecting with them over the phone, completing important non-clinical assessments, identifying barriers to care, and helping them access resources and benefits. We are looking for people who show compassion and document customer issues in detail, can work in a call center environment, and motivate themselves through work that directly supports members and care teams. This is a remote position, and the assigned shift will be 11:30 AM–8:00 PM Eastern Standard Time. Job Description What You Will Do Engage members by phone to encourage participation in care management programs. Complete required assessments and questionnaires to help identify health risks, care needs, and opportunities for clinical team follow-up. Assist members who need support scheduling doctor’s appointments or connecting with appropriate care resources. Identify and help address barriers to preventive screenings, benefits, and health-related services so members can close gaps in care. Support members in understanding, retaining, and accessing benefits that contribute to their overall health and well-being. Manage both inbound and outbound calls in an auto-dialer environment while documenting member information. What Success Looks Like You create a positive member experience by treating each interaction with respect, patience, and professionalism You demonstrate compassion, integrity, and sound judgment when supporting members with sensitive health-related needs You listen to

Become a part of our caring community The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care r

Become a part of our caring community Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials. You will perform thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified. Then, you will provide final determinations utilizing your expertise and collaboration with clinical and other Humana teams. Your contributions will directly support Humana's commitment to delivering high-quality service and making a positive difference in the lives of those we serve. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Key Responsibilities: Assign cases to team members for submission to an independent entity for 2nd level review. Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates. Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision. Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment. Use your skills to make an impact Required Qualifications Minimum of 1 year of customer service experience Minimum of 1 year of data entry experience Experience in a production-driven environment Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.) Ability to manage large volume on inventory daily Preferred Qualifications Previous inbound call center or related customer service experi

Become a part of our caring community The Actuarial Analyst 2, Analytics/Forecasting analyzes and forecasts financial data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Your work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Actuarial Analyst 2, Analytics/Forecasting will report to the Actuary, Analytics/Forecasting. You will play a key role in the Medicare actuarial forecasting process. This position entails the maintenance of the provider revenue and expense projection model and associated tools supporting the projection model. The Actuarial Analyst 2, will be responsible for integrating value-based provider impacts into financial and bid forecasts, managing tools associated with these impacts, and providing guidance on effective risk modeling practices. The Actuarial Analyst 2, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. You will collaborate with stakeholders to understand business needs/issues, troubleshoots problems, conduct root cause analysis, and develop cost effective resolutions for data anomalies. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receives guidance where needed. You will follow established guidelines/procedures. Use your skills to make an impact Required Qualifications Bachelor's Degree Successful completion of at least 3 actuarial exams<

Become a part of our caring community The Director, Product Management Conceives of, develops, delivers, and manages products for customer use. The Director, Product Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director, Product Management Leads all phases of the product life cycle, from inception to introduction into the marketplace, by developing products to meet specific customer needs and achieve specific cost and success outcomes. Once products are launched, monitors efficacy of products and uses customer and business partner feedback to ensure products are meeting customer needs across each customer segmentation, adjusting products over time to continue to achieve the desired outcomes. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, andimplements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. This is a remote position that reports to the Associate VP, Mail Order Pharmacy Distribution. Use your skills to make an impact Required You will be a Certified SAFe® 5 Product Owner/ Product Manager You will have 5&#43; years of Product Owner/Product Manager experience You will have 3&#43; years of leadership experience You will have a Bachelor's degree Preferred You will have an ability to drive significant transformation You will have competence working on very large and most complex assignments You will have asStrong ability to drive cross functional teams to alignment in the midst of ambiguity You will have an abili

Become a part of our caring community Help shape practical, responsible AI solutions that improve healthcare experiences and outcomes. Humana’s Enterprise AI organization develops safe, scalable AI solutions across our Insurance and CenterWell businesses. We bring together product managers, data scientists, engineers, policy experts, and business leaders to apply emerging technology to meaningful healthcare challenges. As Associate Director of Applied AI, you will lead teams that design, build, and deploy enterprise AI solutions, with a focus on generative AI and intelligent agents. You will connect technical strategy to business needs, guide responsible delivery in a regulated environment, and help teams turn promising ideas into measurable outcomes for members, patients, and associates. Key Responsibilities Lead and mentor teams developing production-ready AI solutions that improve healthcare delivery, member experiences, and business operations. Help define and execute the roadmap for applied AI initiatives in alignment with enterprise priorities and business needs. Guide the evaluation and adoption of machine learning, generative AI, large language models, multimodal models, and intelligent agent technologies. Oversee scalable APIs, frameworks, data pipelines, retrieval-augmented generation solutions, and agent orchestration capabilities. Partner with product, data science, engineering, architecture, security, and business teams to translate requirements into reliable solutions. Establish standards for AI evaluation, obse

Become a part of our caring community The Actuarial Analyst 2, Analytics/Forecasting supports value-based initiatives within the HealthCare Economics team, partnering across actuarial, finance, analytics, and business teams to develop actionable financial insights and forecasting solutions. This role will play a key part in the design and development of a holistic modeling solution, building new methodologies and frameworks from the ground up to support performance measurement, financial reconciliation, and strategic decision-making across multiple value-based care programs. You work assignments are varied and frequently require interpretation of complex business issues, independent judgment, and the ability to recommend and execute appropriate courses of action with limited guidance. The Actuarial Analyst 2, Analytics/Forecasting will be responsible for analyzing and forecasting claims and revenue trends, developing innovative forecasting methodologies, and translating complex business requirements into scalable analytical solutions. This individual must be able to independently evaluate data, identify gaps, propose holistic approaches, and develop end-to-end solutions that integrate financial, operational, and claims-based insights. Responsibilities include designing forecasting methodologies, establishing reporting metrics, validating model results, and supporting the evolution of value-based care analytics. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Use your skills to make an impact Required Qualifications Bachelor's Degree Successful completion of

Become a part of our caring community We are seeking a highly experienced Lead Full Stack Engineer to drive engineering excellence across front-end, back-end, API, and data layers. This role is responsible for setting technical direction, ensuring consistent delivery across teams, and aligning engineering solutions with business priorities. The ideal candidate will be a strong technical leader who thrives in complex environments, drives modernization initiatives, and develops high-performing engineering talent. This role offers the opportunity to shape the future of our engineering landscape, influence enterprise-scale decisions, and lead transformation initiatives that directly impact customer experience and business growth. Location : Louisville, KY or Dallas, TX (Work At Home with occasional office visits) Key Responsibilities Engineering Leadership & Strategy Lead full stack engineering strategy and execution across UI, APIs, and data platforms Define architectural direction and ensure high standards for code quality, scalability, and maintainability Select frameworks, languages, and platforms across front-end, back-end, APIs, and data layers Approve architectural patterns (monolith vs. microservices, cloud strategy, and integrations) Identify opportunities to refactor, modernize, or retire legacy systems Delivery Execution & Prioritization Drive consistent delivery across multiple engineering teams through: Sprint planning and execution Dependency management Risk mitigation Removal of technical and organizational blockers Prioritize feature development, platf

Become a part of our caring community The Associate VP, Quality Engineering carries out procedures to ensure that all information systems products and services meet organization standards and end-user requirements. The Associate VP, Quality Engineering requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Associate VP, Quality Engineering performs and leads tests of software to ensure proper operation and freedom from defects. May create test data for applications. Documents and works to resolve all complex problems. Reports progress on problem resolution to management. Devises improvements to current procedures and develops models of possible future configurations. Acts as information resource about assigned areas to technical writers. Performs complex work flow analysis and recommends quality improvements. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy. Use your skills to make an impact Required Qualifications Bachelor's degree in a technology field Extensive experience in the information technology field Demonstrated success in leading and developing a team of associates. Expertise in software testing methodologies Record of success in leading quality improvement initiatives Certified Software Test Engineer (CSTE) designation. Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Master's degree in a technology field Additional Informa

Become a part of our caring community The Dental Recontracting Professional initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides dental insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This is a VSP role - work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. The Dental Recontracting Professional - VSP will recontract Humana contracted dentists to our new agreement and as needed will communicates contract terms, payment structures, and reimbursement rates to providers. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures and work special projects as needed. This role is Variable Staffing Pool (VSP), Variable Staffing Pool Humana associates work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. This role is also eligible for limited benefits. Use your skills to make an impact Required Qualifications 2 - 5 years of experience negotiating managed care contracts with physician, hospital and/or other provider contracts and/or working with insurance in a dental office Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures a

Become a part of our caring community Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject matter expert in VBP and have advanced technical knowledge and experience. Develop new innovative VBP models for range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value. Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments. Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care. Creation of VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals. Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance. Partner with finance team to conduct impact analysis and modeling for new VBP models. Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models. Contribute to developing solutions to operational gaps. Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data. Ability to translate strategy into models that can be piloted and scaled across markets. <

Become a part of our caring community The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Inbound Contacts Representative serves as a primary point of contact for customers, providing support through phone, digital, and written channels. This role handles a variety of customer inquiries, resolves issues, and delivers accurate information while ensuring a positive customer experience. The position performs moderately complex customer service, administrative, and operational support activities, manages semi-routine assignments with minimal guidance, and exercises sound judgment to support quality service and customer satisfaction. As an Inbound Contacts Representative, you will: Respond to customer inquiries by phone, digital, or written channels, including benefits questions, issue resolution, and member education. Accurately document customer interactions, requests, concerns, and resolutions in applicable systems. Research and resolve customer issues, escalating complex or unresolved matters as appropriate. Apply established policies, procedures, and resources to deliver accurate and timely support. Use critical thinking and sound judgment to address customer needs and recommend solutions. Manage workload effectively, prioritize tasks, and meet quality and service expectations. Work independently within established guidelines while supporting customer satisfaction and business objectives. Use your skills to make an impact Required Qualifications 3