Senior Process Improvement Professional

Humana; Annapolis (MD); Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work possible

Job summary

Humana, Inc. is seeking two Senior Process Improvement Professionals to lead enterprise member movement enhancements and Medicaid waiver modernization initiatives.

You will partner across Enrollment, Clinical, Claims, Finance, and Technology to design and sustain enterprise solutions that reduce manual effort, improve data integrity, and mitigate operational risk. The roles require experience in healthcare/Medicaid process improvement, strong analytical and leadership skills, and the ability to

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, waiver, or member administration experience preferred.

Responsibilities

• Lead Enterprise Member Movement Enhancements and own initiatives to improve large-scale member movement accuracy and efficiency.
• Partner with IT and business stakeholders to define requirements, test, validate results, and support implementation.
• Identify operational risks and develop solutions to improve responsiveness with minimal adverse impacts across functions.
• Monitor post-implementation performance to ensure expected outcomes are achieved.
• Lead Medicaid Waiver Modernization efforts and oversee LTSS waiver processes and updates.
• Develop scalable processes that reduce manual intervention and improve waiver data accuracy.
• Act as a liaison between business operations, technology, finance, claims, clinical, and enrollment teams.
• Facilitate stakeholder alignment on priorities, requirements, testing strategies, and implementation plans.
• Communicate project progress, risks, dependencies, and recommendations to leadership.
• Support training, change management, and adoption efforts for new processes and capabilities.
• Identify opportunities to automate processes and improve performance.
• Establish governance and monitoring to support compliance and operational excellence.
• Analyze processes and recommend enhancements for efficiency and scalability.

Skills

Healthcare experience

Medicaid experience

Process improvement

Cross-functional leadership

Analytical skills

Risk management

Requirements gathering

Testing strategies

Excel

Power BI

Tools

Power BI

Microsoft Excel

Pivot tables

Macros

Job description

Become a part of our caring community

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.

Number of Openings: 2 Senior Process Improvement Professionals. These positions will provide dedicated support for Medicaid member mass movement enhancements and multiple waiver administration initiatives while ensuring effective governance of LTSS waiver operations and related business processes.

Use your skills to make an impact

Required 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.

Preferred Qualifications

• 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.

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

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.

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: 11-13-2026

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 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.