Full-Time

Senior Technical Product Owner

Stars & HEDIS Data

Posted on 9/9/2025

Deadline 10/10/25
Humana

Humana

10,001+ employees

Medicare Advantage health insurer for seniors

Compensation Overview

$94.9k - $130.5k/yr

+ Bonus Incentive Plan

Louisville, KY, USA

Remote

Strong preference for Kentucky based candidate able to come to the office once a month or more.

Category
Product (1)
Required Skills
Agile
SCRUM
Requirements
  • Bachelor’s degree in a technical discipline (i.e. Computer Science, Engineering or related field)
  • 5 years or more of experience in data product development and management, or a related technical role
  • Strong experience with healthcare data, particularly clinical and claims data used in HEDIS measurement
  • Familiarity with CMS Stars programs, NCQA standards, and quality performance metrics
  • Experience working with data platforms, ETL tools, and APIs
  • Knowledge of NCQA, CMS, and health plan quality measurement programs
  • Familiarity with platforms, languages, and design principles for cloud, data storage, and connectivity
  • Deep understanding of healthcare interoperability standards (e.g., HL7, FHIR, X12)
  • Ability to interpret measure specifications and translate them into data requirements
  • Excellent communication skills; ability to engage technical and non-technical stakeholders.
Responsibilities
  • Identify new data sources, maintain connections to valuable sources, decommission unneeded sources
  • Monitor data volume, quality, age, and timeliness of data fed to an internal CQE through numerous stage gates
  • Define and maintain the product vision, roadmap, and backlog for the HEDIS data processing pipeline
  • Develop and maintain the support and monitoring apps and processes along with reportable metrics for uptime, data volume and quality
  • Act as the primary liaison between business stakeholders, compliance teams, data engineers, production support and the CMS HEDIS rules engine team
  • Understand regulatory requirements and be able to draft detailed SAFe stories with success criteria to modify data feeds as NCQA rulesets change
  • Work closely with data architects and engineers to design data flows that ingest, clean, validate, and transform clinical and claims data for HEDIS measurement
  • Ensure proper integration with the CMS HEDIS engine, supporting efficient and accurate quality metric calculations
  • Validate data mappings and transformations, especially where they impact measure logic
  • Stay up to date with evolving CMS, NCQA, and HEDIS requirements
  • Ensure the data processing pipeline remains compliant with CMS mandates, audit standards, and data submission deadlines
  • Coordinate updates in response to yearly HEDIS specification changes
  • Collaborate with QA, compliance, and analytics teams to define data quality benchmarks and testing protocols
  • Serve as the subject matter expert for how data supports HEDIS quality measures and reporting
  • Maintain a groomed product backlog; prioritize features, bugs, and technical debt with input from all stakeholders
  • Lead Agile ceremonies (e.g., sprint planning, backlog refinement) in coordination with the Scrum Master or Engineering Lead.
Desired Qualifications
  • Experience with HEDIS rules engines such as Inovalon, Cotiviti, or proprietary solutions
  • Background in data quality frameworks, or clinical informatics
  • Experience with cloud platforms such as Snowflake and Databricks.

Humana focuses on health and well-being by offering Medicare Advantage plans (HMO, PPO, and PFFS) mainly for seniors, military personnel, and communities. Its products are health insurance plans funded through a mix of government contracts and member premiums, enrolling members to provide comprehensive coverage with flexible benefits and a broad provider network. Members receive care through a network of providers, with additional services such as free language interpretation to improve accessibility. Humana differentiates itself through its emphasis on inclusivity, accessibility, and tailored benefits, aiming to deliver reliable service and high renewal rates. The goal is to improve health outcomes and overall well-being for members by delivering coverage that meets diverse needs and making care accessible to all.

Company Size

10,001+

Company Stage

IPO

Headquarters

Louisville, Kentucky

Founded

1961

Simplify Jobs

Simplify's Take

What believers are saying

  • Medicare Advantage membership grew 25% to 7.1 million in Q1 2026.
  • CenterWell added 110,500 patients sequentially via MaxHealth acquisition.
  • Cost Plus Drugs partnership automates prescriptions through SwiftyRx AI.

What critics are saying

  • Star Ratings drop to 20% in 4+ plans erodes $3.5 billion bonuses in 2026.
  • 89.4% benefit ratio from coding changes compresses margins below $9 EPS.
  • UnitedHealthcare's 77% 4+ star plans capture Humana's enrollees in 2026.

What makes Humana unique

  • Humana leads with 13.4% market share in Vision Insurance.
  • CenterWell integrates senior primary care and pharmacies for Medicare members.
  • b.well platform enables real-time health data from 2.4 million providers.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Unlimited Paid Time Off

Paid Vacation

Paid Parental Leave

Short-term Disability

Long-term Disability

401(k) Retirement Plan

401(k) Company Match

Wellness Program

Company News

Yahoo Finance
Apr 12th, 2026
Humana appoints healthcare investment expert to board as shares trade 80% below fair value

Humana has appointed Robert S. Field to its Board of Directors, adding healthcare investment and regulatory expertise to its governance structure. The appointment follows direct shareholder input and comes as the health insurer faces valuation scrutiny. Field's background in healthcare investments and legal matters positions him to contribute to discussions on payment models, technology adoption and risk oversight. The addition may influence Humana's priorities across growth initiatives and regulatory engagement. Humana's shares currently trade at $192.15, reflecting a 16.2% gain over the past month but a 33.8% decline over the past year. The stock trades at a price-to-earnings ratio of 19.4, below the healthcare industry average of 22.0. Analysts have set a target price of $212.08, approximately 9% above current levels.

Business Wire
Apr 9th, 2026
Humana goes live with b.well to enable real-time health data access across providers and health plans

Humana has launched a partnership with b.well Connected Health to enable members to securely access and share their health data across providers, pharmacies and health plans. The collaboration supports Humana's commitment to the CMS Health Technology Ecosystem. Through b.well's national health data network, Humana members can connect data from 2.4 million providers and 350 health plans in one place. The platform uses a 13-step data refinery process to normalise and enrich fragmented data into complete longitudinal health records. The partnership allows Humana to access member data in real-time during claims processing and respond to data requests from providers, supporting care coordination and quality improvement. The initiative aims to reduce administrative burden whilst giving individuals greater control over their health information.

Yahoo Finance
Mar 12th, 2026
Humana revenue beats at $32.6B as health insurers face tougher Q4 quarter

Clover Health posted the strongest Q4 results among health insurance providers, reporting revenues of $487.7 million, up 44.7% year on year and beating analyst expectations by 4.4%. The company delivered a solid quarter with revenue outperformance and EPS in line with estimates. The 12 health insurance providers stocks tracked reported a slower Q4 overall. As a group, revenues beat consensus estimates by 0.8%, whilst next quarter's revenue guidance was in line. Share prices have struggled, down 8.4% on average since latest results. Humana reported revenues of $32.64 billion, up 11.8% year on year, exceeding expectations by 1.8%. However, the company missed full-year EPS guidance estimates significantly. The stock has fallen 3.9% since reporting. The health insurance sector faces regulatory scrutiny and rising medical costs alongside opportunities from an ageing population and data analytics advancements.

Yahoo Finance
Feb 26th, 2026
UnitedHealth vs. Humana: Which healthcare stock offers more upside amid Medicare Advantage growth?

UnitedHealth and Humana, two major US managed care providers, face evolving healthcare landscapes shaped by rising medical costs and changing government programmes. Both have significant Medicare Advantage exposure but differ in business models. UnitedHealth, valued at $248.2 billion, operates a diversified structure combining UnitedHealthcare insurance with Optum health services. Fourth-quarter 2025 revenues rose 12.3% year-over-year, with UnitedHealthcare up 17.5% and Optum up 8%. The company is advancing AI-driven initiatives in claims processing and care coordination. Medicare Advantage membership increased 7.6% year-over-year. Humana maintains a more concentrated focus on government-sponsored plans and value-based care. The article compares their scale, vertical integration and revenue mix to assess which stock offers greater upside potential.

MarketScreener
Feb 13th, 2026
CenterWell acquires Florida's MaxHealth, expanding senior primary care to 82 clinics and 80,000 patients

CenterWell, the healthcare services division of Humana, has completed its acquisition of MaxHealth from Arsenal Capital Partners and the company's founder-shareholders. Financial terms were not disclosed. MaxHealth operates a network of 82 owned and affiliated clinics across West and South Florida, serving over 120,000 patients, including more than 80,000 in value-based care programmes. Founded in 2015, the company employs over 530 staff, including 100-plus primary care providers and 30-plus specialists. The acquisition expands CenterWell Senior Primary Care, the nation's largest senior-focused, value-based primary care provider, into new key Florida markets. MaxHealth was formed through the combination of three physician-founded organisations under Arsenal's ownership. Guggenheim Securities and Morgan Stanley advised MaxHealth, whilst JP Morgan Securities advised Humana and CenterWell.

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