Encounter Data AI & Automation Lead

🕒 August 10

🇺🇸 United States – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟠 Senior

🤖 Artificial Intelligence

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 and automation initiatives to improve encounter data accuracy and efficiency • 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 • Work across business and technical teams to identify opportunities, optimize outcomes, and scale automation solutions • Report to the Director, Encounter Data Management

🎯 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 • Familiarity with claims adjudication systems (CAS) or encounter submission platforms such as Edifecs • Experience supporting or partnering with data science teams • Background in process automation or transformation initiatives • 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 space lacking ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Internet expense payment for associates or contractors who live and work from home in California • Remote work arrangement with occasional travel to Humana offices for training or meetings