Encounter Data Lead – AI & Automation

Job not on LinkedIn

🕒 August 10

🇺🇸 United States – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟠 Senior

📊 Data Scientist

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead AI-driven reconciliation and automation initiatives to improve encounter data accuracy and efficiency • Own the performance and continuous improvement of AI models used in reconciliation processes • Monitor and evaluate AI model performance, reconciliation rates, error trends, and data quality outcomes • Identify gaps and partner with technical teams to enhance models and improve results • Analyze complex data issues and use AI-driven insights to determine root causes and solutions • Collaborate with business and technical partners to prioritize enhancements and automation opportunities • Communicate AI performance, risks, and progress to stakeholders in a clear, actionable way • Maintain and prioritize a roadmap of AI improvements, backlog items, and automation initiatives • Work independently to solve complex problems and make decisions based on data and business impact • Report to the Director, Encounter Data Management • Attend occasional travel to Humana offices for training or meetings

🎯 Requirements

• 4+ years of experience working with AI or machine learning models, including monitoring and improving model performance • 4+ years of experience working in a healthcare environment • 2+ years of project or program leadership experience • Experience using data to identify trends, solve problems, and improve processes • Ability to work across teams and communicate technical concepts to non-technical audiences • Experience working with AI/ML tools, data platforms, or automation technologies preferred • Familiarity with claims adjudication systems (CAS) or encounter submission platforms such as Edifecs preferred • Experience supporting or partnering with data science teams preferred • Background in process automation or transformation initiatives preferred • Ability to provide a high-speed DSL or cable modem for a home office • Minimum internet speed of 25 Mbps download and 10 Mbps upload • Satellite and wireless internet service is not allowed • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Internet expense payment for associates or contractors who live and work from home in California • Remote work arrangement • Home office internet requirements support