Senior Process Improvement

CenterWell; Lexington (KY); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana is seeking a Senior Process Improvement Professional to own end-to-end interoperability and medical documentation chase operations. You will map current and future-state processes, define operating models, and partner with business, product, and IT teams to document requirements and ensure systems support operational needs.

This remote role offers 40 hours weekly, a pay range of $78,400 to $107,800 per year, and eligibility for a bonus incentive plan.

Qualifications

• Lead the design and stand-up of new processes supporting interoperability and medical documentation chase operations, including defining the end-to-end operating model and implementation approach
• Build and maintain end-to-end workflows, including intake, triage, routing, exception handling, escalation paths, and reporting requirements
• Serve as the subject matter expert for the full operational process and associated system interactions, ensuring strong understanding of upstream inputs and downstream impact
• Partner with business, product and IT stakeholders to gather, document, and refine business and system requirements for new functionality
• Translate operational needs into functional requirements, business rules, user stories, process maps and supporting documentation
• Facilitate cross-functional working sessions to define current-state, future-state, and target-state processes; identify gaps, risks, controls, and dependencies across teams and system
• Recommend and implement sustainable process improvements that improve efficiency, quality, scalability, and operational readiness
• Support solution design, testing, training, SOP/job aid development and change readiness activities for new process launches and enhancements

Responsibilities

• Lead the design and stand-up of new processes supporting interoperability and medical documentation chase operations, including defining the end-to-end operating model and implementation approach
• Build and maintain end-to-end workflows, including intake, triage, routing, exception handling, escalation paths, and reporting requirements
• Serve as the subject matter expert for the full operational process and associated system interactions, ensuring strong understanding of upstream inputs and downstream impact
• Partner with business, product and IT stakeholders to gather, document, and refine business and system requirements for new functionality

Skills

End-to-end process ownership

Interoperability operations

Requirements gathering & documentation

Cross-functional collaboration

Process design & modeling

Change management support

SOP development & training

Education

Bachelor's degree or equivalent

Job description

Become a part of our caring community This position is created specifically to assist with Humana's efforts to secure and, if awarded, transition into a new business opportunity. Please note that continued employment in this role is expressly contingent upon Humana's receipt of the business opportunity and a satisfactory transition into the work. In the event Humana does not pursue the opportunity or determines that a timely and satisfactory transition cannot be achieved, employment may be subject to termination.

The Senior Process Improvement Professional serves as the end-to-end process owner and subject matter expert for interoperability and medical documentation chase operations. This role will assess business needs, design new workflows, define operating models, and develop process standards, controls, and performance measures to support successful implementation. The associate will partner closely with business stakeholders, product teams and IT to document requirements for system functionality, identify dependencies, and ensure technology solutions align to operational needs.

The Senior Process Improvement Professional will map current and futurestate processes, identify gaps, risks, and opportunities, and recommend sustainable solutions that improve accuracy, efficiency, and stakeholder experience. This role will help establish business rules, intake requirements, routing logic, exception handling, reporting needs, and governance processes for new work. The associate will also support change management, implementation planning, testing and operational readiness activities to ensure successful launch and adoption.

The role requires developing deep expertise across the full end-to-end process, including upstream inputs, downstream impacts, stakeholder roles, system touchpoints and compliance considerations. The Senior Process Improvement Professional makes decisions on moderately complex to complex issues regarding process design, requirements, and implementation approach, and performs work with limited direction while exercising considerable latitude in determining objectives and methods.

Use your skills to make an impact

Required Qualifications

• Lead the design and stand-up of new processes supporting interoperability and medical documentation chase operations, including defining the end-to-end operating model and implementation approach
• Build and maintain end-to-end workflows, including intake, triage, routing, exception handling, escalation paths, and reporting requirements
• Serve as the subject matter expert for the full operational process and associated system interactions, ensuring strong understanding of upstream inputs and downstream impact
• Partner with business, product and IT stakeholders to gather, document, and refine business and system requirements for new functionality
• Translate operational needs into functional requirements, business rules, user stories, process maps and supporting documentation
• Facilitate cross-functional working sessions to define current-state, future-state, and target-state processes; identify gaps, risks, controls, and dependencies across teams and system
• Recommend and implement sustainable process improvements that improve efficiency, quality, scalability, and operational readiness
• Support solution design, testing, training, SOP/job aid development and change readiness activities for new process launches and enhancements

Preferred Qualifications

• Bachelor's degree or equivalent professional experience
• Experience standing up new processes, workflows or operating models from the ground up
• Experience gathering, documenting, and refining business and system requirements
• Experience working cross-functionally with business, product and IT stakeholders
• Strong written and verbal communication skills, including process documentation and executive-ready material
• Strong analytical and problem-solving skills, including identifying process gaps, risks, and dependencies

Work at Home Requirements

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. 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

$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.

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 encouraging 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.

About us

About 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 at Humana.com and at CenterWell.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.