Remote Senior Healthcare Process Improvement Lead

Humana, Inc.; San Juan (PR); Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana, Inc. is seeking a Senior Process Improvement Professional to analyze and improve complex business processes across D-SNP operations. You will measure effectiveness, develop repeatable improvements, and align with CMS and Medicaid requirements while partnering with IT, compliance, claims, and clinical teams.

The role emphasizes data-driven decision making, benchmark analysis, and driving automation to reduce manual work and risk. Travel may be required for training or meetings.

Qualifications

• 3–5+ years in process improvement, operations or healthcare.
• Experience with D-SNP, Medicare/Medicaid programs.
• Knowledge of CMS regulations and state Medicaid requirements.
• Bachelor’s degree in business, Healthcare Administration, Industrial Engineering, or related field.

Responsibilities

• Lead end-to-end process improvement initiatives across D-SNP operations.
• Analyze workflows, identify root causes, and propose sustainable solutions.
• Partner with stakeholders across IT, compliance, claims, enrollment, customer service, and clinical teams.
• Develop business requirements, process maps, and future-state operational designs.
• Monitor KPIs, service levels, quality metrics, and compliance outcomes.
• Drive automation and modernization to reduce manual work and operational risk.
• Facilitate cross-functional meetings, decision-making, and change management activities.
• Support regulatory readiness and adherence to CMS, state Medicaid and Medicare requirements.
• Present findings, recommendations, and executive summaries to leadership.

Skills

Process improvement

Analytical thinking

Executive communication

Process mapping

Cross-functional collaboration

Education

Bachelor’s degree

Tools

Lucidchart

Visio

Job description

Humana, Inc. is seeking a Senior Process Improvement Professional to analyze and improve complex business processes across D-SNP operations. You will measure effectiveness, develop repeatable improvements, and align with CMS and Medicaid requirements while partnering with IT, compliance, claims, and clinical teams.

The role emphasizes data-driven decision making, benchmark analysis, and driving automation to reduce manual work and risk. Travel may be required for training or meetings.