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Humana Senior Process Improvement Professional (HealthCare, Provider Value exp.) Work at Home in Salem, Oregon


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 Provider Process Improvement Professional supports provider experience arising under the Medicaid Operating Model, including work across the value chain (i.e. claims, contracting and provider servicing). They will manage projects, identify trends and emerging issues, recommend solutions and ensure timely, complete responses to business partners and senior leaders.

  • Focus on process improvement and standardization - ensuring the coordination of the components of the provider experience

  • Deploys a proactive and consultative approach to providing strategic thought leadership to identify and address complex issues

  • Analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable and quantifiable business process improvements

  • Identify trends, conduct risk assessments, and identify areas of improvement resulting from information obtained through business partners

  • Research best practices and determine how technology can support re-engineering business processes

  • Review processes regularly to identify areas of improvement

  • Collaborate with key Medicaid business partners, including: Contracting, Credentialing, Referral/Authorizations, Claims, Grievance and Appeals, Market leadership, etc.

Required Qualifications

  • Minimum of a Bachelor's degree in Business, Healthcare, or related field and/or 8+ years of equivalent job experience

  • 5+ years' experience in the Healthcare Industry

  • 2+ years of professional knowledge of provider value stream work: contracting, claims, and/or provider relations

  • Data trending and analysis experience

  • Proficient in MS Office

  • Highly motivated to grow process improvement knowledge and skills

  • Ability to identify problems, uncover efficiencies and implement process improvements

  • Self-starter and critical thinker

  • Stellar communication skills and ability to positively influence others

  • Able to exercise considerable independent judgment and initiative

  • Passionate about contributing to an organization focused on continuously improving

  • Work At Home requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

  • COVID Vaccination :  We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.  If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.

Preferred Qualifications

  • 5+ years' experience in Medicaid or another Government program

  • Previous experience in leading cross-functional teams on large-scale projects

  • PMP Certification

  • Six Sigma Certification

Additional information

  • Schedule: Monday to Friday from 8 am to 5 pm. Alternative schedule possible.

  • Training: Training is ongoing, there is some virtual foundational trainings that will take place within the first few weeks

  • Work Location (Address): Waterfront Plaza, Louisville KY, or WAH nationwide

  • % Travel: Less than 10%

Scheduled Weekly Hours