Encounter Data AI & Automation Lead

Become a part of our caring community   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. Key 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 Use your skills to make an impact   Required Qualifications 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 Preferred Qualifications 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 Additional Information Work-At-Home Requirements WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. 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 Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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. $94,900 - $130,500 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 08-02-2026 About us   About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel