Senior Process Improvement Professional

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

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 researches best business practices within and outside the organization to establish benchmark data. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. Determines how new information technologies can support re-engineering business processes. May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Key Responsibilities

• Lead end-to-end process improvement initiatives across D-SNP operations.
• Analyze operational workflows, identify root causes, and recommend sustainable solutions.
• Partner with business stakeholders, IT, compliance, claims, enrollment, customer service, and clinical teams.
• Develop business requirements, process maps, and future-state operational designs.
• Monitor and improve key performance indicators (KPIs), service levels, quality metrics, and compliance outcomes.
• Drive automation and modernization efforts 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.

Required Qualifications

• Experience supporting Dual Eligible Special Needs Plans (D-SNP), Medicare Advantage, Medicaid, or government healthcare programs.
• Knowledge of CMS regulations and state Medicaid requirements.
• 3-5+ years of process improvement, operations, healthcare, or managed care experience.
• Strong analytical and problem-solving skills.
• Strong written and verbal communication skills, including executive presentations.
• Experience using process mapping and documentation tools (lucid, Visio)

Preferred Qualifications

• Bachelor’s degree in business, Healthcare Administration, Industrial Engineering, or related field.
• Familiarity with enrollment, eligibility, claims, care management, provider operations, or member services.
• Experience with root cause analysis and continuous improvement methodologies.
• Proven ability to influence stakeholders without direct authority.
• Experience leading complex, enterprise-wide initiatives, and process redesign efforts.

Additional Information

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.