Value Based Programs Business Intelligence Lead

**Become a part of our caring community and help us put health first** Join Humana-recognized as a Fortune Top Company and one of the Best Places to Work-as a Value Based Programs Business Intelligence Lead. In this impactful position, you will play a key role in shaping and scaling innovative value-based programs across diverse markets. You will leverage your expertise to design and build sophisticated data models, ensuring accurate member-to-provider attribution and delivering actionable insights to evaluate program effectiveness. This is a unique opportunity to lead strategic decision-making on data modeling approaches and data visualization, directly influencing how our providers and leadership teams understand and improve healthcare outcomes. If you are passionate about driving change through analytics and want to make a meaningful difference at a leading organization, we invite you to apply and be part of our dynamic team. The Value Based Programs Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision makers. The Business Intelligence (BI) Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The BI Lead describes the tools, technologies, applications and practices used to collect, integrate, analyze and present an organization's raw data to create insightful and actionable business information. This role advises executives to develop functional strategies on matters of significance and exercises independent judgement and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. This individual uses independent judgement requiring analysis of variable factors and determining the best course of action. **Key Responsibilities** + Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care. + Design and develop data models to attribute members to providers and evaluate program effectiveness for new value-based programs + Design and develop value-based programs to scale while compensating for differences between each market + Model development and report creation of provider performance and reconciliation based on contractual terms. + Analyze utilization data to reconcile provider disputes. + Design and develop provider reporting packages to help providers understand their overall performance. + Partner with finance team to conduct impact analysis and modeling for new VBP models. + Collaborate with cross-functional and matrixed teams to operationalize and roll out new VBP models. + Develop and monitor VBP model performance key performance indicators (KPIs) to identify opportunities to enhance model design based on internal and external feedback and performance data. + Design and develop Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, STARS etc. + Ensure data integrity in program administration for all value-based programs + Troubleshoot data integrity issues and offer solutions to solve challenges **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + Minimum 8 years of technical experience in data analysis or Master's degree and 4 years of experience + 2 or more years of project leadership experience + Advanced experience working with big and complex data sets with large organizations + Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction + Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs + Proficiency in understanding Healthcare related data + Proficiency in verbal and written communication to senior and executive leadership + Strong organizational skills and ability to manage multiple or competing priorities + Strong attention to detail + Experience in Medicaid, Medicaid managed care and/or DSNP + Experience with multiple tools for creating data visualizations + Experience in a system analytics and/or data warehousing environment + Experience in SQL and other data systems **Preferred Qualifications** + Advanced degree in quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field + Experience with Azure Synapse Analytics (ASA) and/or Databricks + Advanced experience in SQL, SAS and other data systems + Experience performing data analysis and developing solutions to inform key stakeholders on PCP and/or specialty Value-Based programs + Expertise in data mining, forecasting, simulation and/or predictive modeling + Experience creating analytics solutions for various healthcare sectors **Additional Information** **Location/Work Style:** Remote US **Why Humana?** At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few: + Work-Life Balance + Generous PTO package + Health benefits effective day 1 + Annual Incentive Plan + 401K - Excellent company match + Well-being program + Paid Volunteer Time Off If you share our passion for helping people, we likely have the right place for you at Humana. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **SSN Alert Statement** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $117,600 - $161,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 11-21-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our