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 business processes and develops sustainable, repeatable, and quantifiable improvements. The role handles moderately complex to complex assignments that require in-depth evaluation of variable factors. This position provides business ownership and leadership for strategic Medicaid enrollment and waiver modernization initiatives supporting operational efficiency, regulatory compliance, and accurate member administration. The professional partners across Enrollment, Clinical, Claims, Finance, and Technology to design, implement, and sustain enterprise solutions that reduce manual effort, improve data integrity, and mitigate operational risk. The work focuses on member movement capabilities and waiver administration enhancements with significant downstream organizational impacts. The role leads enterprise member movement enhancements, Medicaid waiver modernization, cross-functional coordination, continuous improvement, and governance. It supports requirements definition, testing, implementation, operational readiness, training, change management, performance monitoring, and scalable process improvement. This is a remote position; occasional travel to Humana offices for training or meetings may be required. Work-from-home employees must have a dedicated workspace that protects member PHI/HIPAA information and internet service meeting the stated speed requirements.

Requirements

Experience leading complex healthcare, Medicaid, process improvement, operational, or technology initiatives.
Demonstrated success managing cross-functional projects involving multiple business areas.
Strong analytical, problem-solving, and risk management capabilities.
Experience developing business requirements, testing strategies, operational processes, and implementation plans.

Nice To Haves

Medicaid managed care, enrollment, eligibility, waiver, or member administration experience.
Experience with Medicare and/or Medicaid.
Experience with Medicare Reconciliation.
Experience analyzing, interpreting, and displaying financial, health, competitive, and performance measurement data.
Experience leading strategy and/or operational planning.
Experience consulting to, and/or influencing, executive leadership.
Experience influencing change in a matrix organization.
Experience with Microsoft Excel chart creation, macros, and pivot tables.
Experience with Power BI.

Responsibilities

Lead enterprise initiatives that improve the accuracy and efficiency of large-scale member movement activities.
Partner with Information Technology and business stakeholders to define requirements, conduct testing, validate results, and support implementation.
Identify operational risks and develop solutions that improve responsiveness while minimizing effects on clinical, claims, finance, and enrollment operations.
Monitor post-implementation performance to ensure expected business outcomes are achieved.
Provide operational ownership and oversight for enhancements supporting multiple Medicaid waivers.
Manage and govern LTSS waiver-related processes, including waiver updates, validations, and issue resolution.
Assume responsibility for the LTSS mailbox and coordinate timely review, validation, and processing of waiver-related member information.
Develop and implement scalable processes that reduce manual intervention and improve waiver data accuracy.
Act as a liaison between business operations, technology, finance, claims, clinical, and enrollment teams.
Facilitate stakeholder alignment on priorities, business requirements, testing strategies, implementation plans, and operational readiness.
Communicate project progress, risks, dependencies, and recommendations to leadership.
Support training, change management, and adoption for new processes and capabilities.
Identify opportunities to automate manual processes and improve operational performance.
Establish monitoring, reporting, and governance practices that support compliance and operational excellence.
Analyze business processes and recommend enhancements to improve efficiency, scalability, and member experience.
Support enterprise transformation initiatives focused on Medicaid operations and enrollment modernization.