Hybrid VP, Provider Services – Experience

at Humana

• Job title: VP, Provider Services – Experience
• Job type: Full Time
• Experience level: Lead
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Tech skills: Cloud, Cyber Security, Microservices, RPA
• Location requirements: Hybrid, United States

About the role

• Vice President, Provider Services leading strategic technology initiatives for Humana's provider experience platforms across insurance lines. Overseeing significant resources and modernizing legacy systems for improved provider engagements.

Responsibilities

• Enterprise Provider Experience Strategy – Spearhead the modernization and integration of Humana’s provider technology, servicing and experience platforms across all insurance lines of business. Ensure these systems support efficient and simplified provider onboarding, credentialing, communication, and data management with high accuracy, scalability, and compliance. Partner with key servicing organizations (e.g., digital, growth, data, AI, infrastructure, cybersecurity) to define, simplify, and enhance provider touchpoints. Partner with enterprise business and technology leaders for Provider to both launch the provider next best action engine and standup provider engagement and product build capabilities. Prioritize capabilities into core, adjacent, and transformational capability horizons to address pain points
• Provider Technology Leadership – Own the technology strategy and execution for Humana’s provider platforms, servicing and engagement operations. Ensure platforms meet the unique regulatory, operational, and experience requirements of the provider segment. Collaborate closely with segment and enterprise technology leaders to align technology investments with business objectives and compliance mandates.
• Platform Modernization – Drive the transformation of legacy provider systems into agile, interoperable platforms that support real-time data exchange, automation, and seamless integration across: - Provider Onboarding, Credentialing and Contracting: Streamline onboarding and verification processes to enhance provider engagement. - Provider Communications & Support: Ensure timely, accurate, and targeted communications, and facilitate easy access to support and resources. - Provider Technology Enablers: Deliver key technology enablers required to achieve our strategy, including provider systems of record, provider mastering, agentic platform deployment, portals, etc. - Claims & Payment Servicing: Accountable for provider, contract and pricing setup. Partner with platform teams (e.g. Claims), to ensure efficient claims management, accurate payment processing, and transparent reconciliation for providers. - Regulatory Reporting: Support timely and accurate submissions to state and federal agencies for provider-related compliance.
• Strategic Technology Leadership & Segment Partnership - Serve as the strategic technology leader for Humana’s Provider platforms across all insurance lines. Ensure technology investments are aligned with enterprise priorities and the distinct regulatory and operational needs of these segments. Translate business strategies into actionable technology roadmaps that drive compliance, scalability, and provider-centric innovation.
• Provider Platform Stewardship - Oversee the modernization and integration of platforms supporting provider enrollment, credentialing, contracting, directory management, and servicing. Manage intake and prioritization of business needs, ensuring timely, value-driven delivery across interconnected systems. Collaborate with enterprise platform teams to maintain alignment and operational continuity.
• Architecture & Engineering Excellence - Lead solution and domain architecture for Provider platforms, ensuring interoperability, scalability, and resilience. Drive modernization of legacy systems through cloud-native, API-first, and real-time data exchange architectures. Oversee application and data engineering to ensure alignment with enterprise standards and digital transformation goals.
• Interoperability & Ecosystem Integration - Ensure seamless integration between Provider platforms and adjacent domains such as Core Admin, Claims, Benefits, Membership, Utilization Management, and Care Management. Champion platform interoperability to support dynamic provider engagement, regulatory reporting, and enhanced digital experiences across Medicare and Specialty lines.
• Financial & Vendor Governance - Manage complex technology budgets and vendor relationships to ensure strategic alignment and cost-effectiveness. Lead contract negotiations, performance oversight, and governance of third-party partners supporting Provider platforms.
• Regulatory Compliance & Risk Management - Ensure all platforms meet enterprise standards for cybersecurity, data governance, and regulatory compliance. Proactively identify and mitigate risks related to data integrity, system performance, and regulatory reporting.
• Operational Excellence & Innovation Enablement - Drive operational excellence across provider platforms by implementing intelligent automation (e.g., RPA, BPM), advanced analytics, and AI/ML to streamline workflows, reduce errors, and elevate service quality. Architect scalable, cloud-native solutions using microservices, containers, and serverless technologies to ensure agility and resilience. Enable real-time insights through modern data pipelines and predictive analytics, while enhancing provider experiences via secure, self-service portals and APIs. Foster innovation through emerging technologies like generative AI and NLP, supporting new business models and continuous improvement in provider engagement and servicing.
• Talent Development & Organizational Leadership - Lead and develop high-performing, global technology teams. Foster a culture of accountability, innovation, and continuous improvement. Build organizational capabilities to support evolving business needs and enterprise-wide transformation.

Requirements

• Education: Bachelor’s degree in Computer Science, Information Technology, or related field.
• Enterprise Engineering Leadership: 10+ years leading large-scale, global engineering organizations in healthcare, insurance, or regulated industries.
• Platform Modernization: Proven success modernizing legacy systems and architecting scalable, cloud-native, API-first platforms across Provider or related industry domains.
• Automation & Optimization: Demonstrated ability to drive enterprise-wide automation, interoperability, and performance improvements in provider or related regulated industry workflows.
• AI & Emerging Tech: Hands-on experience applying AI, machine learning, and digital technologies to transform operations and enhance member/provider experiences.
• Medicaid, Specialty Technology Strategy: Deep understanding of CMS regulations specific compliance, with experience aligning technology investments to segment growth and regulatory needs.
• Security & Compliance: Strong background in cybersecurity, data governance, and risk mitigation across complex, interconnected platforms.
• Financial & Vendor Management: Expertise in managing multimillion-dollar technology budgets and strategic vendor partnerships, including contract negotiation and performance oversight.
• Global Team Leadership: Proven ability to build, mentor, and scale high-performing engineering teams across geographies, fostering innovation and accountability.
• Strategic Execution: Strong analytical and problem-solving skills with a track record of translating business goals into actionable technology roadmaps.
• Cross-Functional Collaboration: Ability to partner with clinical, business, and technology leaders to deliver integrated, enterprise-wide solutions.

Benefits

• Health insurance
• 401(k) matching
• Flexible work hours
• Paid time off
• Professional development opportunities