[Hiring] Process Improvement Lead @Humana

Role Description

This is a remote position. You will serve as a strategic partner to encounter leadership, translating priorities into decisions, action, and measurable results. You will organize complex work, build relationships across teams, and present clear recommendations to C-suite executives. Using data and stakeholder input, you will establish governance, anticipate risks, clarify accountability, and improve Medicaid encounter submission performance. You will report to the Director, Encounter Data Management.

Key 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.
• Demonstrated experience preparing and presenting business risks, results, or recommendations to C-suite executives or equivalent senior leaders.

Qualifications

• Bachelor's degree.
• 5+ years of experience in process improvement, business operations, strategy, or program leadership.
• 2+ years of experience leading cross-functional projects or enterprise initiatives.
• 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.

Requirements

• Experience with Medicaid or Medicare encounter data.
• Experience with healthcare claims processing.
• Experience with governance, regulatory readiness, dashboards, or corrective action planning.
• Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps; dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Travel: Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive benefits that support whole-person well-being.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.