Actuary, Medicaid Trend Analytics and Data Management

Become a part of our caring community and help us put health first

Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to support modeling, reporting, and decision-making. Requires strong project management skills to evaluate the downstream impacts of data changes on actuarial models, reporting tools, and financial results. Lead and manage data-related projects from scoping through post-production validation, partnering with teammates to implement data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with actuarial, financial, and clinical teams to assess and determine optimal data solutions. Provide strategic recommendations on data architecture and improvements. Support team in identification of cost drivers, utilization patterns, and anomalies in Medicaid medical claims data.

The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. This role collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies.

Typical responsibilities, but not limited to:

• Advises executives to develop functional strategies (often segment specific) on matters of significance.

• Analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions.

• Establishes metrics, provides data analyses, and works directly to support business intelligence.

• Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position.

• Exercises independent judgment and decision making regarding job duties and related tasks and works under minimal supervision.

• Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree

• FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.

• MAAA

• Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)

• Demonstrated project management skills with the ability to drive work independently and effectively lead through collaboration

• Experience in managing large healthcare claim datasets and conducting trend analysis

• Advanced knowledge of Databricks, SQL, or Python

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Preferred Qualifications

• Ability to translate complex data into actionable insights

• Effective communication skills for technical and non-technical audiences

• Skilled in gathering customer input and translating it into clear business requirements that align with customer needs and objectives

• Deep understanding of healthcare claims taxonomy (service categories, such as LTSS)

Additional information

HireVue Statement

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN 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 Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

Work at home statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees 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 employees 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.

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.

$129,300 - $177,800 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: 12-30-2025

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.

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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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.