Senior BI Engineer- Medicaid Value Based Programs

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

The Senior Business Intelligence Engineer 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. Makes an impact to the department's strategy. Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Generates ad hoc reports and regular datasets and/or report information for end-users using queries and scripts to inform value-based payment (VBP) model design and administration. Create technical specifications for reports based on business requests.

This position will report to the Associate Director, Value-Based Programs.

Key Responsibilities

• Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.

• Analyze utilization data to reconcile provider disputes.

• Design and contribute to the development of the provider reporting packages to help providers understand their overall performance.

• Contribute to the development of data models to attribute members to providers for new and enhancements to existing value-based programs and to evaluate program effectiveness

• Perform quality assurance checks with peers and lead Business Intelligence associates to ensure development of the program meets business requirements

• 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.

• Monitor VBP model performance 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, etc.

• Ensure data integrity in program administration for new 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

• 5 or more years of technical experience in data analysis OR Master's degree and 3 or more years of experience in data analysis

• Advanced in SQL, SAS and other data systems

• Experience with tools such as Power BI and DAX language for creating data visualizations

• Proficiency in verbal and written communication to senior and executive leadership

• Advanced experience working with big and complex data sets within large organizations

• Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction

• Comprehensive knowledge of Microsoft Office Applications including Word, Excel, Access and PowerPoint

• Strong organizational skills and ability to manage multiple or competing priorities

• Proficiency in understanding Healthcare related data

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Strong attention to detail

Preferred Qualifications

• Medicaid and Medicaid managed care experience

• Experience performing claims data analysis to inform VBP model design

• Advanced Degree in quantitative disciplines, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field

• Expertise in data mining, forecasting, simulation, and/or predictive modeling

• Create analytics solutions for various healthcare sectors

Work-At-Home Requirements

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.

Interview Format

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

If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview.  In this interview, you will receive a set of interview questions over your phone, and you will provide recorded or text message responses to each question. For best interview experience use a computer over a phone.  You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Humana Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including: Health benefits effective day 1 Paid time off, holidays, volunteer time and jury duty pay Recognition pay 401(k) retirement savings plan with employer match Tuition assistance Scholarships for eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities

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.

 

$89,000 - $121,400 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: 03-09-2026

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.