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Humana

Sells Medicare health plans and runs senior clinics

Lead Product Manager - Compliance Ops

Business OperationsPosted on Nov 9
Full-timeRemote in USA

About the Job

Requirements

  • A bachelor’s degree or equivalent experience is required.
  • At least 5 years of experience in Product Management, Product Operations, Healthcare Technology, Technical Operations, Business Analysis, or a related field is required.
  • At least 3 years of experience leading cross-functional initiatives involving business and technology teams is required.
  • Experience owning or supporting production APIs, integration platforms, technology products, or healthcare data exchange capabilities is required.
  • Experience with partner onboarding, implementation, production operations, or technical support is required.
  • Experience coordinating production issues and escalations across business and technology teams is required.
  • Experience working within healthcare payer, provider, healthcare technology, or interoperability environments is required.
  • Knowledge of healthcare interoperability technologies and standards, including APIs, FHIR, HL7, OAuth, or related healthcare data exchange technologies is required.
  • Experience developing and managing operational processes, support models, procedures, documentation, and performance metrics is required.
  • Experience translating operational needs and production findings into prioritized backlog items is required.
  • Experience working in Agile environments and collaborating with Product Owners and technology delivery teams is required.

Responsibilities

  • Own day-to-day operations of Humana’s FHIR APIs and interoperability products, including Patient Access, Provider Access, Payer-to-Payer, Prior Authorization, Provider Directory, and related capabilities.
  • Monitor API operational performance, production issues, support trends, incidents, dependencies, and operational risks.
  • Coordinate with IT stakeholder teams to investigate and resolve API incidents, service issues, defects, and other production concerns.
  • Establish operational ownership, escalation paths, procedures, and handoffs across Product, IT, Architecture, Security, Identity and Access Management, and other supporting teams.
  • Communicate API operational health, significant incidents, risks, dependencies, and remediation status to leadership and stakeholders.
  • Own the end-to-end onboarding experience for providers, payers, third-party applications, and other approved partners requesting access to Humana’s interoperability APIs.
  • Manage onboarding from initial request through registration, access and authentication coordination, connectivity, testing, production enablement, and transition into ongoing support.
  • Coordinate onboarding activities and dependencies across business, IT, security, identity, architecture, and other stakeholder teams.
  • Develop and maintain standardized onboarding processes, supporting documentation, intake procedures, partner communications, and escalation paths.
  • Monitor onboarding performance and identify opportunities to reduce delays, simplify processes, improve partner experience, and increase operational scalability.
  • Own the post-onboarding support model for Humana’s FHIR APIs and external interoperability partners.
  • Establish processes for partner questions, support requests, production issues, incident escalation, issue triage, and ongoing partner communications.
  • Coordinate with IT stakeholder teams responsible for technical investigation and resolution while maintaining ownership of the overall support experience.
  • Ensure issues have clear ownership, appropriate prioritization, documented resolution paths, and effective communication with impacted stakeholders.
  • Identify recurring support issues and trends requiring operational remediation.
  • Own continuous operational improvement of Humana’s FHIR API ecosystem.
  • Analyze incidents, support trends, onboarding friction, operational metrics, recurring issues, and partner feedback to identify improvement opportunities.
  • Identify opportunities for process simplification, automation, improved monitoring, enhanced documentation, and more scalable operational support.
  • Translate identified operational needs into operational enhancements and backlog items and work with Product Owners and delivery teams to prioritize and implement them.
  • Ensure enhancements owned by this role remain focused on operational effectiveness, supportability, reliability, onboarding, and production operations, rather than new business capabilities or strategic product enhancements.
  • Partner with Regulatory Compliance while maintaining a clear separation between operational ownership and regulatory compliance ownership.
  • Provide Regulatory Compliance with API operational, onboarding, support, performance, and other relevant data as requested.
  • Maintain operational documentation and records to support compliance inquiries, assessments, and audit-readiness activities.
  • Define and maintain operational reporting and metrics covering API operations, onboarding, support demand, issue resolution, service performance, and operational improvements.
  • Drive collaboration across Product, Product Owners, IT, Architecture, Security, Identity and Access Management, Regulatory Compliance, Operations, and other stakeholder teams.
  • Serve as a central point of operational coordination for FHIR API-related onboarding, production support, and operational issues.
  • Communicate operational performance, risks, trends, and improvement opportunities to senior leadership.
  • Maintain current operational procedures, onboarding materials, support documentation, requirements, and business artifacts.
  • Mentor Product Managers and Product Owners on FHIR API operations, partner onboarding, production support, and operational product management practices.

Desired Qualifications

  • A master’s degree in Business Administration, Healthcare Administration, Public Health, Information Systems, or a related field is preferred.
  • SAFe Agile, Product Management, ITIL, or related product/operations certification is preferred.
  • Experience operating FHIR APIs in a production healthcare environment is preferred.
  • Experience supporting CMS interoperability capabilities, including Patient Access, Provider Access, Payer-to-Payer, Prior Authorization, and Provider Directory APIs is preferred.
  • Experience managing provider, payer, or third-party application API onboarding and production support is preferred.
  • Experience with API registration, authentication, authorization, identity and access management, and partner connectivity processes is preferred.
  • Knowledge of production support disciplines, including incident management, problem management, root-cause analysis, escalation management, monitoring, and service performance, is preferred.
  • Experience using operational data and support trends to drive continuous improvement and backlog prioritization is preferred.
  • Experience defining or managing operational KPIs, SLAs, onboarding metrics, and support performance metrics is preferred.
  • Familiarity with healthcare integration technologies, HIT, EDI, API gateways, and API management platforms is preferred.
  • Experience with Azure DevOps and Agile product management practices is preferred.

About the Company

Humana

Sells Medicare health plans and runs senior clinics

Humana sells health insurance paid for by government programs, chiefly Medicare Advantage plans that private insurers run for Americans 65 and older in place of traditional Medicare. It ranks among the largest Medicare Advantage insurers in the country and also runs Medicaid plans for low-income families in several states. Its CenterWell business operates senior primary care clinics, a mail-order pharmacy and home health services, so many members get care from a company the insurer owns. Medicare and states pay Humana a set monthly amount per member, and it keeps the difference between those payments and members' medical costs. Humana was founded in 1961 as a nursing home company and is based in Louisville, Kentucky.

Company size
10,001+
Company stage
IPO
Headquarters
Louisville, KY
Founded
1961

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