Process Improvement Lead

Humana

3d•$94,900 - $130,500•Remote

About The Position

The Process Improvement Lead is a strategic partner to encounter leadership, translating priorities into decisions, action, and measurable results. The role organizes complex work, builds relationships across teams, and presents recommendations to C-suite executives. Using data and stakeholder input, the Lead establishes governance, anticipates risks, clarifies accountability, and improves Medicaid encounter submission performance. The position reports to the Director, Encounter Data Management. This is a remote position. Occasional travel to Humana offices for training or meetings may be required. Home-based employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. The role is scheduled for 40 hours per week and is not eligible for work visa sponsorship.

Requirements

Bachelor's degree.
At least 5 years of experience in process improvement, business operations, strategy, or program leadership.
At least 2 years of experience leading cross-functional projects or enterprise initiatives.
At least 2 years of experience processing medical claims and/or encounter submissions.
Demonstrated experience organizing multiple priorities, stakeholders, decisions, and deadlines.
Demonstrated experience building relationships and influencing across functions without direct authority.
Demonstrated experience preparing and presenting business risks, results, or recommendations to C-suite executives or equivalent senior leaders.

Nice To Haves

Experience with Medicaid or Medicare encounter data.
Experience with healthcare claims processing.
Experience with governance, regulatory readiness, dashboards, or corrective action planning.

Responsibilities

Partner with encounter leadership to set priorities, prepare decisions, and drive follow-through on strategic initiatives.
Organize multiple priorities, meetings, decisions, owners, and timelines to keep complex work moving.
Build trusted relationships across operations, technology, compliance, markets, vendors, providers, and regulatory partners.
Prepare and present concise updates, risks, options, and recommendations to C-suite executives and other senior leaders.
Lead governance forums focused on performance, risks, dependencies, decisions, and regulatory readiness.
Translate complex encounter processes and business needs into clear workflows, dashboards, insights, and decision points.
Anticipate regulatory, platform, volume, and data quality risks before they affect encounter submissions.
Drive cross-functional issues from root cause analysis through solution development, executive communication, and resolution.
Create and maintain processes and documentation for Medicaid contract compliance and risk oversight.
Use data to challenge assumptions, recommend priorities, and improve inefficient processes respectfully and constructively.