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[Hiring] In Home Eligibility Lead @Humana

June 5, 2026

Role Description

The Program Delivery Lead strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Program Delivery Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The IHWA In‑Home Eligibility Lead is responsible for overseeing and managing eligibility strategy, execution, and data integrity for in‑home Quality Focused Visit (QFV) and related IHWA vendor programs. This role ensures:

Accurate member targeting
Consistent eligibility logic
Timely file delivery across multiple vendor partners

This supports high‑quality execution, Stars outcomes, and operational scalability. The Eligibility Lead partners closely with:

IHWA operations
Stars
Analytics
IT
External vendors

Key responsibilities include:

Designing and maintaining eligibility criteria
Minimizing overlap across in‑home programs
Proactively identifying and resolving eligibility risks
Translating program and quality requirements into executable eligibility rules, data files, and automated processes

Operating with a high degree of autonomy, the IHWA In‑Home Eligibility Lead analyzes complex data, exercises sound judgment, and drives continuous improvement in eligibility processes to support program growth, vendor performance, and member experience. The role also supports:

The transition from manual processes to automated, scalable solutions
Ensuring readiness for future growth and evolving business needs

Qualifications

Bachelor’s degree in business, healthcare administration, public health, information systems, or a related field; equivalent experience considered
5+ years of experience in healthcare operations, program delivery, eligibility management, or performance analytics
Demonstrated experience managing eligibility criteria and file delivery across multiple vendors or partners
Strong understanding of in‑home healthcare programs, quality initiatives, or Stars‑related workflows preferred
Proven ability to work with complex data sets, including eligibility files, member lists, and disposition data
Experience collaborating cross‑functionally with IT, analytics, operations, and vendor partners
Strong analytical and problem‑solving skills, with the ability to identify eligibility risks, inconsistencies, or gaps
Excellent communication skills, including the ability to explain complex eligibility logic to technical and non‑technical stakeholders
Ability to manage multiple priorities and deadlines in a fast‑paced, high‑visibility environment
Proficiency with SQL
Proficiency with data and reporting tools (e.g., Excel, SQL, Power BI, Tableau, or similar)

Requirements

Experience supporting Quality Focused Visits (QFV) or similar quality‑driven in‑home programs
Familiarity with Medicare Advantage, Stars measures, and member eligibility requirements
Experience designing or managing daily eligibility file processes and automation initiatives
Background in vendor governance, performance monitoring, or contract support
Experience defining eligibility logic, prioritization rules, and exclusion criteria to minimize overlap and operational risk
Knowledge of data governance, data quality controls, and audit readiness
Experience working with APIs or automated data exchanges with external partners
Master’s degree in healthcare administration, public health, data analytics, or a related field

Remote-Work-At-Home Requirements

Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense
Humana will provide telephone equipment appropriate to meet business requirements
Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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.

$115,200 - $158,400 per year

This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Many other opportunities

Application Deadline

06-12-2026

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...