Encounter Data Lead – AI & Automation

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead initiatives focused on AI-driven reconciliation and automation to enhance the accuracy and efficiency of encounter data.

• Take ownership of the performance and ongoing enhancement of AI models utilized in reconciliation activities.

• Monitor and assess the performance of AI models, reconciliation rates, error patterns, and data quality results.

• Identify deficiencies and collaborate with technical teams to improve models and achieve better outcomes.

• Analyze complex data challenges and leverage AI-driven insights to identify root causes and propose solutions.

• Work alongside business and technical partners to prioritize enhancements and explore automation opportunities.

• Clearly communicate AI performance, associated risks, and progress to stakeholders in an actionable manner.

• Maintain and prioritize a roadmap for AI improvements, backlog items, and automation initiatives.

• Operate independently to resolve complex issues and make data-driven decisions that impact the business.

• Report directly to the Director of Encounter Data Management.

• Occasionally travel to Humana offices for meetings or training sessions.

⛳️ Requirements

• A minimum of 4 years of experience working with AI or machine learning models, with a focus on monitoring and enhancing model performance.

• At least 4 years of experience in a healthcare setting.

• Over 2 years of experience in project or program leadership roles.

• Proficient in utilizing data to identify trends, resolve issues, and enhance processes.

• Capability to collaborate across teams and convey technical concepts to non-technical stakeholders.

• Preferred experience with AI/ML tools, data platforms, or automation technologies.

• Familiarity with claims adjudication systems (CAS) or encounter submission platforms like Edifecs is advantageous.

• Experience supporting or collaborating with data science teams is preferred.

• Background in process automation or transformation initiatives is a plus.

• Must provide a high-speed DSL or cable modem for a home office setup.

• Minimum internet speed requirement of 25 Mbps download and 10 Mbps upload.

• Satellite and wireless internet services are not permitted.

• A dedicated workspace that minimizes interruptions to safeguard member PHI/HIPAA information is essential.

🏝️ 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 reimbursement for associates or contractors residing and working from home in California.

• Remote work arrangement.

• Support for home office internet requirements.