[Hiring] Senior Process Improvement Professional @Humana

Role Description

The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Process Improvement Professional will provide business ownership and leadership for strategic Medicaid enrollment and waiver modernization initiatives that support operational efficiency, regulatory compliance, and accurate member administration. These roles will partner across Enrollment, Clinical, Claims, Finance, and Technology teams to design, implement, and sustain enterprise solutions that reduce manual effort, improve data integrity, and mitigate operational risk.

The positions will be dedicated to advancing member movement capabilities and waiver administration enhancements that have significant downstream impacts across the organization.

Key Responsibilities

• Lead Enterprise Member Movement Enhancements
  • Serve as a business lead for initiatives that improve the organization's ability to execute large-scale member movement activities accurately and efficiently.
  • Partner with Information Technology and business stakeholders to define requirements, conduct testing, validate results, and support implementation activities.
  • Identify operational risks and develop solutions that improve responsiveness while minimizing impacts to clinical, claims, finance, and enrollment operations.
  • Monitor post-implementation performance to ensure expected business outcomes are achieved.
• Lead Medicaid Waiver Modernization Efforts
  • Provide operational ownership and oversight for enhancements supporting the administration of multiple Medicaid waivers.
  • Manage and govern LTSS waiver-related processes, including oversight of waiver updates, validations, and issue resolution activities.
  • 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.
• Cross-Functional Leadership
  • 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 efforts for new processes and capabilities.
• Continuous Improvement and Governance
  • Identify opportunities to automate manual processes and improve operational performance.
  • Establish monitoring, reporting, and governance practices to support compliance and operational excellence.
  • Analyze business processes and recommend enhancements that improve efficiency, scalability, and member experience.
  • Support enterprise transformation initiatives focused on Medicaid operations and enrollment modernization.

Qualifications

• 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.
• Medicaid managed care, enrollment, eligibility, waiver, or member administration experience preferred.

Requirements

• 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.

Benefits

• 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.

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.

$78,400 - $107,800 per year

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

Application Deadline

11-13-2026

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.