Description
Become a part of our caring community and help us put health first
The Senior Process Improvement Professional, DSNP Encounters Data Management supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement organization (HQRI).
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 partner with multiple teams and leaders to execute existing and new state implementations to include solving for business issues and/or opportunities related to monitoring DSNP encounter submissions and payments. They will be responsible for the creation of process flows and will write policy and procedure documents.
You will partner closely with peers across the organization to enhance business processes while identifying opportunities, interpret data, produce recommendations and track plans to completion. Support communication efforts through summaries on status of multiple projects and reporting on trends and metrics.
This role exercises independent judgment and decision making on moderate issues regarding job duties and related tasks and works under minimal supervision. This role will develop and maintain partnerships with a diverse group of teams and develop trusted relationships as they work side by side to accomplish goals. The individual will also work on medium-scale projects and moderate complexity.
In this role, you will:
- Develop and maintain reporting mechanisms to track, trend and monitor success and results.
- Lead and influence project completion by fostering collaborative partnerships, identifying opportunities and solving challenges.
- Design end to end process flows inclusive of technical architecture to identify opportunities, hand offs, clarity roles and responsibilities, and controls and monitoring needed.
- Communicate and present effectively, listen actively, and attentively to others, build relationships.
- Own execution of daily operating objectives and goals, report outs, key performance metrics.
- Ability to manage multiple tasks, priorities, and deadlines with diligence.
- Ability to understand state and regulatory compliance.
Use your skills to make an impact
Required Qualifications
- Minimum 2 years of process improvement/implementation and/or project management experience.
- Detail oriented with excellent organizational and project management skills.
- Take ownership of process improvement projects and serve as a Subject Matter Expert on high-visibility initiatives.
- Demonstrates autonomy in managing tasks, proactively advancing projects, and appropriately escalating challenges.
- Builds and sustains a robust network of collaborative professional relationships.
- Communicates effectively in both written and verbal formats, fostering meaningful connections across teams and stakeholders.
- Translates complex concepts into clear, actionable insights tailored to diverse audiences.
- Applies analytical expertise to independently investigate intricate issues and uncover root causes.
- Navigates shifting priorities with ease, maintaining productivity across multiple tasks.
- Expert experience utilizing Microsoft applications such as Word, Excel, PowerPoint, and Lucid.
Preferred Qualifications
- Minimum 1 year of experience medical claims payment and processing in a medical claim’s environment
- Experience creating pivot tables and consumable information within Excel
- Knowledgeable in regulations governing health care industries or related adjacent industries
Additional Information
Work-At-Home Requirements:
- WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
- A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
- Satellite and Wireless Internet service is NOT allowed for this role.
- 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 exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-23-2025
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.
