Become a part of our caring community and help us put health first

As a Process Improvement Lead, you’ll play a key role in analyzing and enhancing business processes that directly impact our members, providers, and partners. You’ll tackle complex challenges, identify opportunities for efficiency, and implement sustainable, data-driven solutions that make a real difference.
This is your opportunity to lead cross-functional initiatives, apply your expertise in healthcare claims, and shape the future of operational excellence in a dynamic, mission-driven environment.

The Process Improvement Lead is responsible for identifying, analyzing, and implementing strategies to improve operational efficiency, service quality, and overall performance across the enterprise shared service functions and National Medicaid Operations functions serving the Medicaid segment. Partners with cross-functional teams to drive continuous improvement, reduce waste, and align processes with strategic financial and compliance goals. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.Use your skills to make an impact

Required Qualifications

Bachelor’s degree in business, Operations, or related field
5+ years of experience in health care process improvement, or project management, or operations (Medicaid specific preferred)
5+ years of experience in the healthcare industry
2+ years of demonstrated expertise in end-to-end healthcare claims operations, including claim ingestion, processing, system navigation, payment workflows, and issue resolution
Proven ability to lead cross-functional teams and manage multiple priorities effectively
Strong analytical skills with experience in data analysis and process mapping tools (e.g., virtual whiteboarding tools, Power BI).
Knowledge of change management practices and applicability to process improvement initiatives
Excellent communication, facilitation, and stakeholder management skills

Preferred Qualifications

Master’s degree in Business, Operations, or related field
Medicaid experience with provider functions, which may include contracting, configuration, claim payments
Experience with DSNP and LTSS products
Six Sigma or Lean certification
Change Management Certification (Prosci or CCMP)
Humana Claims Platform/System Knowledge and Experience

Additional Information

Schedule: 8:00 AM – 5:00 PM ET, with flexibility to accommodate other time zones as needed
Work Location: Nationwide Stateside
Work Style: Remote

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.