Senior Process Improvement Professional

Humana

1d•$78,400 - $107,800•Remote

About The Position

The Senior Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable improvements. The role addresses moderately complex to complex issues requiring in-depth evaluation of variable factors, works without direction, and exercises considerable latitude in setting objectives and approaches. It begins to influence department strategy. The position researches business practices within and outside the organization to establish benchmarks; collects and analyzes process data; and recommends practices and procedures to improve safety and productivity while reducing cost. It determines how information technologies can support process re-engineering and may specialize in benchmarking, process analysis and re-engineering, change management and measurement, or process-driven systems requirements. The role leads end-to-end process improvement across D-SNP operations, partnering with business stakeholders and teams across IT, compliance, claims, enrollment, customer service, and clinical operations. It supports regulatory readiness and compliance with CMS, state Medicaid, and Medicare requirements. This is a remote role with occasional travel to Humana offices for training or meetings. Work-from-home employees must have a dedicated workspace that protects member PHI/HIPAA information and internet service with at least 25 Mbps download and 10 Mbps upload speeds.

Requirements

Experience supporting Dual Eligible Special Needs Plans (D-SNP), Medicare Advantage, Medicaid, or government healthcare programs.
Knowledge of CMS regulations and state Medicaid requirements.
3-5+ years of process improvement, operations, healthcare, or managed care experience.
Strong analytical and problem-solving skills.
Strong written and verbal communication skills, including executive presentations.
Experience using process mapping and documentation tools such as Lucid or Visio.

Nice To Haves

Bachelor’s degree in business, Healthcare Administration, Industrial Engineering, or a related field.
Familiarity with enrollment, eligibility, claims, care management, provider operations, or member services.
Experience with root cause analysis and continuous improvement methodologies.
Proven ability to influence stakeholders without direct authority.
Experience leading complex, enterprise-wide initiatives and process redesign efforts.

Responsibilities

Lead end-to-end process improvement initiatives across D-SNP operations.
Analyze operational workflows, identify root causes, and recommend sustainable solutions.
Partner with business stakeholders and IT, compliance, claims, enrollment, customer service, and clinical teams.
Develop business requirements, process maps, and future-state operational designs.
Monitor and improve key performance indicators (KPIs), service levels, quality metrics, and compliance outcomes.
Drive automation and modernization efforts to reduce manual work and operational risk.
Facilitate cross-functional meetings, decision-making, and change management activities.
Support regulatory readiness and adherence to CMS, state Medicaid, and Medicare requirements.
Present findings, recommendations, and executive summaries to leadership.
Research business practices inside and outside the organization to establish benchmark data.
Collect and analyze process data and recommend business practices and procedures focused on improved safety, productivity, and cost reduction.
Determine how information technologies can support business process re-engineering.