Process Improvement Lead

004 Humana Insurance Company; United States; Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Bonus plan

Job summary

Humana, Inc. is seeking a strategic partner for Encounter Data Management to translate priorities into decisions and measurable results. This remote role involves organizing complex work, building cross-team relationships, and presenting to C-suite executives.

You will influence governance, data quality, and regulatory readiness for Medicaid encounter submissions. The position reports to the Director, Encounter Data Management.

Qualifications

• Bachelor's degree required with 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.

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 updates, risks, options, and recommendations to C-suite executives and senior leaders.
• Lead governance forums focused on performance, risks, dependencies, decisions, and regulatory readiness.

Skills

Process improvement

Cross-functional leadership

Stakeholder management

Data-driven decision making

Relationship building

Education

Bachelor's degree

Job description

Become a part of our caring community 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. Use your skills to make an impact This role is not eligible for work visa sponsorship.

Required 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.

Preferred Qualifications

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

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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

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

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. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.

Application Deadline

11-06-2026

About us

Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.