Senior Process Improvement Professional

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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.

• 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.

• 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)

• 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.

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…