Community Manager in United States

Become a part of our caring community The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Financial Analytics Professional 2 collates, models, interprets and analyzes data in order to identify, explain, influence variances and trends. Explains variances and trends in clinical and financial data and enhances modeling techniques to improve forecast accuracy. May possess financial or actuarial background. 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. Use your skills to make an impact Required Qualifications Bachelor's Degree 1&#43; years SQL and Python experience Microsoft Office (Excel, Power BI, etc.) Experience in compiling, modeling, interpreting and analyzing data in order to identify, explain, influence variances and trends Explain variances and trends and enhance modeling techniques Experience in managing data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Business Intelligence, Financial, or Actuarial background Azure Databricks experience</

Become a part of our caring community The Associate Vice President, Model & AI Governance, is the enterprise leader responsible for establishing and overseeing the organization’s framework for model governance, artificial intelligence (AI) risk management, responsible AI and AI governance. Reporting to the Chief Audit & Risk Officer, this executive provides independent second-line oversight and challenge of the organization’s use of models, advanced analytics, machine learning, generative AI, and emerging AI technologies. The role establishes the governance, risk-management, control, monitoring and escalation framework necessary to ensure AI models are deployed in a manner that is safe, ethical, transparent, explainable, compliant, secure and aligned with the organization’s mission and risk appetite. The Associate Vice President, Model & AI Governance, partners closely with executive leadership, technology, data and analytics, clinical/business leaders, compliance, legal, privacy, cybersecurity, information security, internal audit, enterprise risk management and other control functions to ensure AI-related risks are identified, assessed, governed, monitored, and appropriately reported. This leader will serve as an advisor to executive management on emerging model and AI risks, while maintaining appropriate independence from the teams developing and deploying models and AI solutions. Key Responsibilities Own and continuously enhance the enterprise model governance framework, including model identification, inventory, classification, risk tiering, development, validation, approval, implementation, monitoring, change management, retirement and documentation. Define model risk appetite, risk taxonomy, minimum control standards, governance requirements and escalation thresholds. Provide effective challenge over model

Become a part of our caring community The Senior Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Process Improvement Professional researches best business practices within and outside the organization to establish benchmark data. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. Determines how new information technologies can support re-engineering business May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact Required Qualifications The Sr. Process Improvement Professional must meet one, (1) of the following requirements: Licensed Professional (LSW) in the state of Kentucky OR ability to obtain, Master’s degree from an accredited university or college in social work, psychology or related health and human services area with a minimum of one, (1) year professional experience in case management.

Become a part of our caring community The Software Engineer 2 plays a key role in developing and maintaining solutions that support secure and reliable file transfers between external partners and internal systems, with a strong emphasis on Hyland OnBase integrations and enterprise content management solutions. You will be responsible for designing, configuring, and supporting integrations between Hyland OnBase, the organization's Record Management System, and web applications to enable efficient file upload and download capabilities, document management, and seamless business process automation. You will bring experience in Hyland OnBase administration, configuration, and integration, along with strong technical skills in C#, .NET, HTML, CSS, SSIS, SQL, and related tools. You will also troubleshoot complex issues, gather and translate requirements, document technical solutions, and work collaboratively across teams to ensure secure, compliant, and reliable system performance. Our Department of Defense Contract requires U.S. citizenship for this position. This is a hybrid position which requires associates to come into the Louisville KY office at least 2 days per week. You will report to the Associate Director, HGB IT Platform and Foundational Services for Humana Military. Required Qualifications 1 or more years' experience supporting or developing integrations with Hyland OnBase Experience with enterprise content management, system configuration, and application interoperability Proficiency in C#, .NET, SQL, SSIS, HTML, and CSS Experience designing and implementing API integrations Strong analytical, troubleshooting, and problem-solving skills Strong verbal and written communication skills, including technical documentation Successfully

Become a part of our caring community The Provider Contracting Professional supports the West Region in the negotiation, analysis, and maintenance of physician and other provider agreements for an organization delivering healthcare to the senior population. You will assist with contract management activities, provides analytical support, and ensure accurate documentation within established processes and guidelines. You will report to a Director, Provider Contracting. Job Responsibilities: Support the contracting team in drafting, reviewing, and processing provider contracts and amendments Collaborate with market engagement, leadership, and legal teams to facilitate contract execution and resolve basic contract term revisions Assist in communicating contract terms, payment structures, and reimbursement rates to IPA and ACO provider groups under the guidance of senior staff Conduct initial financial analyses of contracts and terms; prepare summaries for senior review Maintain contract files and documentation within the organization's tracking system, ensuring accuracy and compliance Assist in identifying and reaching out to potential providers for network development based on current needs and network composition Prepare reports and updates for contracting initiatives as requested Manage assigned priorities and deadlines, escalating complex issues to senior team members Use your skills to make an impact Required Qualifications 2&#43; years' experience in provider contracting, network management, or a related healthcare field Knowledge of managed care or value-based contracting Understand contract terms and basic financial impact Preferred Qualifications Experience supporting ACO or IPA provider

Become a part of our caring community The Legal Operations Professional collects, organizes, and analyzes law department data, including matter management metrics, outside counsel spend, and operational benchmarks. Your work assignments are often straightforward and of moderate complexity. Job Responsibilities: Help with the administration and maintenance of legal technology platforms such as e-billing, matter management, and knowledge management systems Assist with vendor management coordination, including tracking outside counsel performance, processing invoices, and maintaining vendor records Help prepare reports, dashboards, and presentations on law department metrics, spend trends, and benchmarking data to inform leadership decision-making Conduct financial analysis of law department spend data, including reviewing and evaluating law firm and legal service provider pricing structures Helps create financial models to analyze law firm alternative fee arrangements (AFAs), prompt pay discounts, volume discounts, and other fee structures to identify cost savings and optimize outside counsel spend Support the preparation of law firm and legal service provider pricing reviews, including rate benchmarking, fee arrangement comparisons, and value assessments to inform negotiation strategies Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Use your skills to make an impact Required Qualifications Bachelor's degree 1&#43; years experience working in legal operations, legal support, knowledge management, or a related professional services environment Experience collecting, organizing, and analyzing data to support operational reporting and decision-making

Become a part of our caring community You will support the CDAO, SVP of Data and Analytics, helping manage the day-to-day executive support needs of a large and complex organization of approximately 1,500 associates and partners. Delivering on Humana’s purpose of helping people achieve their best health requires a trusted and connected understanding of the people we serve and the ability to turn data and insight into action at scale. The Data & Analytics organization will achieve this vision by creating trusted enterprise data assets, contextualizing them for consumption, modernizing the platforms that power them, establishing clear accountability for their governance, and activating them through analytics, AI, and decision intelligence. This is an opportunity to support the leadership of one of Humana's largest technology organizations and contribute to initiatives that are modernizing healthcare technology, advancing AI-driven capabilities, and improving experiences for millions of members and providers. Success in this role requires exceptional organization, attention to detail, professionalism, and sound judgment. You will help ensure the executive is prepared, organized, and focused on key priorities by managing calendars, coordinating meetings and travel, supporting leadership events, handling communications, and partnering with stakeholders across the organization. What You'll Support Complex calendar management across four senior leaders and stakeholders Executive travel planning, meeting logistics , and event coordination

Become a part of our caring community The Portfolio Enablement Lead is a portfolio transformation leader responsible for shaping and advancing Humana's portfolio operating model, Agile Release Train (ART) design, and Ways of Working across multiple portfolios. Acting as a trusted advisor to executive leadership (SVPs, VPs, and portfolio leaders), this role translates enterprise strategy into scalable portfolio operating models that drive alignment, flow, value delivery, and measurable business outcomes across the organization. This position combines deep expertise in Lean Portfolio Management, enterprise operating model design, organizational transformation, and systems thinking with exceptional executive influence, facilitation, and data-driven decision-making skills. The role focuses on enterprise enablement rather than delivery management, driving portfolio optimization, governance consistency, operating model maturity, and long-term organizational optimization while partnering across business and technology teams to improve enterprise performance and strategic execution. The Portfolio Enablement Lead serves as a trusted transformation leader responsible for advancing Humana's Ways of Working through the design, governance enablement, and evolution of portfolio operating models, ART structures, and leadership practices across assigned portfolios. In this highly influential role, you will collaborate with executive leaders across business and technology to shape how portfolios are structured, prioritized, governed, and executed to achieve strategic business objectives. As a trusted advisor, you will partner directly with SVPs, VPs, Directors, and senior portfolio leaders to align organizational design, portfolio strategy, and operating models with enterprise priorities and regulatory requirements.

Become a part of our caring community The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to team members for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain relevant clinical information in various medical management systems. Understand 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. Use your skills to make an impact Required Qualifications 2&#43; years of RN experience Active RN license in the state of Indiana Ability to be licensed in multiple states without restrictions Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Preferred Qualifications Bachelor's degree MCO experience Health Plan experience working with large carriers Previous Medicare/Medicaid experience Outpatient or home health experience in Utilization Manageme

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 The Market Finance Lead is a key member of the Gulf South Region’s finance team responsible for connecting market financial performance with operational effectiveness. This role will partner closely with Corporate Finance, Network Performance, Network Contracting, and regional Health Services teams. This individual will manage a team covering a diverse set of responsibilities around Medicare Advantage financial business operations with a heavy focus on value-based providers. This role reports to the Market Finance Director. This role analyzes financial results, claims experience, utilization trends, contract performance, membership, and provider performance data to identify opportunities, influence business decisions, and support market growth and operational improvement. The Market Finance Lead will partner closely with regional leadership, actuarial, corporate finance, clinical, risk adjustment, market operations, network performance, network contracting, sales/MarketPoint, and value-based care providers. This individual will translate complex financial and operational data into meaningful insights, recommendations, and action plans that improve performance across the market. As the Market Finance Lead, you will: Manage a team to review value-based providers’ financial performance, membership, cost and utilization trends, contractual results, and opportunities for improvement. Lead the financial portion of provider engagement prep sessions prior to joint operating committee meetings to advise the Network Performance team on contract performance and opportunities for improvement. Lead analysis and reporting related to value-based provider and contract performance, including financial results, utilization, claims experience, membership, and operational trends. Leverage data analytics, business ins

Become a part of our caring community The Senior Portfolio Enablement Lead is a strategic portfolio transformation role responsible for shaping and enabling Humana's portfolio operations, Agile Release Train (ART) design, and Ways of Working across the portfolio. Acting as a trusted advisor to senior executives (SVPs, VPs, and portfolio leaders), the role translates transformation strategy into scalable execution by diagnosing portfolio delivery challenges, guiding organizational design, and improving alignment, flow, and value delivery. As a Senior Portfolio Enablement Lead, you will: Partner with portfolio and organization leadership to develop and enable portfolio, aligned to enterprise portfolio operations to achieve portfolio initiatives their outcomes. Perform quantitative and qualitative assessments, including stakeholder analysis and change impact assessments, to develop data-driven change strategies for key stakeholder groups. Build and manage portfolio transformation roadmaps to drive executive buy-in and sponsor engagement across technology and business/product leadership and leadership to drive understanding and adoption of key changes Develop Release Train Engineers to our Humana Ways of Working and enterprise tooling subject matter experts for Agile Release Trains and Scrum Teams Measure effectiveness of change interventions through defined metrics and continuously evolve plans to optimize adoption outcomes Regularly report activity status to organizational, portfolio and transformation leadership; proactively escalate and help resolve risks and issues Partners with leaders to align all continuous improvement goals and objectives Partner with Release Train Engineers in the portfolio to monitor activity level of continuous improvement, adoption of Humana Ways of Working, risks patterns

Become a part of our caring community The Director, Provider Solutions Engineering devises an effective strategy for executing and delivering on IT business initiatives. We ask that you have an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director, Provider Solutions Engineering serves as the strategic technology leader responsible for defining Humana's Provider engagement and engineering. In partnership with business and operational teams, this role is responsible to identify and implement strategic technology solutions that improve provider engagement, associate effectiveness, and business outcomes. The Director collaborates across a highly matrixed organization to establish technology strategy, drive large-scale transformation initiatives, and deliver modern customer relationship management capabilities that support the end-to-end provider experience. This leader is accountable for translating business priorities into actionable roadmaps, driving execution excellence, strengthening engineering discipline, and ensuring technology investments align with enterprise architecture, regulatory requirements, and organizational objectives. The role is responsible for establishing the future-state Provider engagement vision, accelerating AI-enabled capabilities, modernizing technology platforms, and fostering a high-performing engineering culture that consistently delivers measurable business value. Key Responsibilities Technology Leadership Serve as the strategic technology leader for Provider engagement and related provider experience capabilities. Partner effectively within a matrixed organization to align business priorities, regulatory requirements, architecture standards, and technology investments. Provide strategic dir

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 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