Key skills
Medicare Advantage operationsMedicare regulatory frameworksMedicare reimbursement frameworksMedicare quality frameworksHealthcare leadershipHealth insurance leadershipOperational performance managementFinancial performance managementAdvanced analyticsEnterprise strategic thinkingFinancial acumenExecutive communicationStakeholder influenceAnalyticsLeadershipCommunicationDecision Making
About this role
Humana Inc. is a leading U.S. healthcare company, and they are seeking a Vice President for Medicare Market Operations & Business Performance. This role is responsible for driving market-level operating performance and strategic execution across Medicare Advantage Regions, using data-driven insights to improve growth and member experience.
Responsibilities:
- Lead enterprise oversight of Medicare market operational and financial performance across multiple geographies
- Drive accountability for membership growth, medical cost performance, quality outcomes, and operating margin
- Translate large-scale operational, financial, and clinical data into strategic insights and market interventions
- Identify emerging trends in medical cost, utilization, risk adjustment, and member engagement and deploy targeted performance improvement strategies
- Partner with finance and actuarial leaders to manage Medical Loss Ratio, administrative cost efficiency and margin improvement
- Align operational priorities across the enterprise to ensure consistent delivery of Medicare strategy at the market level
- Monitor competitive market dynamics, regulatory developments, and demographic trends affecting Medicare markets
- Build and lead a high-performing team responsible for Medicare market analytics, operational strategy, and performance governance
- Foster a culture centered on accountability, transparency, and data-driven decision making
Requirements:
- Bachelor's degree required; MBA, MHA, MPH, or related graduate degree strongly preferred
- 15+ years of leadership experience in healthcare or health insurance
- Deep experience in Medicare Advantage operations and market performance management
- Demonstrated success managing large-scale operational and financial performance in complex, matrixed organizations
- Experience driving enterprise performance improvement initiatives using advanced analytics
- Strong familiarity with Medicare regulatory, reimbursement, and quality frameworks
- Enterprise strategic thinking
- Advanced financial and analytical acumen
- Executive communication and stakeholder influence
- Ability to translate data into actionable business strategy
- Proven ability to lead transformation across highly matrixed organizations