Process Improvement Lead

This is a fully remote position, open to applicants in United States.

📋 Description

• Collaborate with encounter leadership to establish priorities, make informed decisions, and ensure execution of strategic initiatives.

• Coordinate priorities, meetings, decisions, owners, and timelines for multifaceted projects.

• Foster relationships across operations, technology, compliance, market sectors, vendors, providers, and regulatory partners.

• Prepare and deliver updates, risks, options, and recommendations to C-suite executives and senior leadership.

• Facilitate governance forums that focus on performance, risks, dependencies, decisions, and regulatory readiness.

• Convert encounter processes and business requirements into workflows, dashboards, insights, and decision-making points.

• Anticipate regulatory, platform, volume, and data quality risks that may impact encounter submissions.

• Address cross-functional issues from root cause analysis to solution development, executive communication, and resolution.

• Develop and uphold Medicaid contract compliance and risk oversight processes and documentation.

• Utilize data to challenge assumptions, suggest priorities, and enhance inefficient processes.

• Report directly to the Director of Encounter Data Management.

• Occasional travel to Humana offices for training or meetings may be necessary.

⛳️ Requirements

• Bachelor’s degree.

• Over 5 years of experience in process improvement, business operations, strategy, or program leadership.

• A minimum of 2 years of experience leading cross-functional projects or enterprise-wide initiatives.

• At least 2 years of experience in processing medical claims and/or encounter submissions.

• Proven experience in managing multiple priorities, stakeholders, decisions, and deadlines.

• Strong ability to build relationships and influence across functions without direct authority.

• Experience in preparing and presenting business risks, results, or recommendations to C-suite executives or equivalent senior leaders.

• Must meet home internet requirements of at least 25 Mbps download and 10 Mbps upload.

• Must work from a dedicated space free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Not eligible for work visa sponsorship.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Remote work opportunities.

• Dedicated home workspace.

• Internet service requirements/support for home work.