Encounter Data AI & Automation Lead

Humana

1d • $94,900 - $130,500 • Remote

About The Position

The Encounter Data Management Lead is responsible for leading AI-driven reconciliation and automation efforts to improve encounter data quality and reduce manual work. In this role, you will own the performance and continuous improvement of AI models used in reconciliation processes. You'll work across business and technical teams to identify opportunities, optimize outcomes, and scale automation solutions. This role requires strong experience applying AI in real-world environments, along with the ability to translate data insights into operational improvements. You will be part of the Encounter Data Management team and 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
• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• 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

Responsibilities

• Lead initiatives that use AI and automation to improve encounter data accuracy and efficiency
• Monitor and evaluate AI model performance, including 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

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed