Process Improvement Lead, Healthcare Claims

Become a part of our caring community and help us put health first As a Process Improvement Lead, you’ll play a key role in analyzing and enhancing business processes that directly impact our members, providers, and partners. You’ll tackle complex challenges, identify opportunities for efficiency, and implement sustainable, data‑driven solutions that make a real difference. This is your opportunity to lead cross‑functional initiatives, apply your expertise in healthcare claims, and shape the future of operational excellence in a dynamic, mission‑driven environment. The Process Improvement Lead is responsible for identifying, analyzing, and implementing strategies to improve operational efficiency, service quality, and overall performance across the enterprise shared service functions and National Medicaid Operations functions serving the Medicaid segment. Partners with cross‑functional teams to drive continuous improvement, reduce waste, and align processes with strategic financial and compliance goals. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action. Use your skills to make an impact Required Qualifications Bachelor’s degree in business, Operations, or related field 5+ years of experience in health care process improvement, or project management, or operations (Medicaid specific preferred) 5+ years of experience in the healthcare industry 2+ years of demonstrated expertise in end‑to‑end healthcare claims operations, including claim ingestion, processing, system navigation, payment workflows, and issue resolution Proven ability to lead cross‑functional teams and manage multiple priorities effectively Strong analytical skills with experience in data analysis and process mapping tools (e.g., virtual whiteboarding tools, Power BI) Knowledge of change management practices and applicability to process improvement initiatives Excellent communication, facilitation, and stakeholder management skills Preferred Qualifications Master’s degree in Business, Operations, or related field Medicaid experience with provider functions, which may include contracting, configuration, claim payments Experience with DSNP and LTSS products Six Sigma or Lean certification Change Management Certification (Prosci or CCMP) Humana Claims Platform/System Knowledge and Experience Additional Information Schedule: 8:00 AM – 5:00 PM ET, with flexibility to accommodate other time zones as needed Work Location: Nationwide Stateside Work Style: Remote WAH Internet Statement 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. Satellite, cellular, and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision‑making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 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, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: . About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large. 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. #J-18808-Ljbffr