Authorization and Referral Claims Process Improvement Lead

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The Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Process Improvement Lead will work closely with the Authorization and Referral Process team on large-scale initiatives and new concepts to help translate business needs into technical requirements.

Key Responsibilities

• Partner with business leaders, teams, and cross-functional groups to lead process analysis and root cause.
• Facilitate workshops, working sessions, and improvement events.
• Communicate progress, risks, and outcomes to leadership.
• Analyze operational data to identify trends and improvement opportunities.
• Build reports/dashboards to monitor improvements and define KPIs and metrics to measure process performance.
• Ensure processes are scalable, repeatable, and compliant.
• Evaluate current business processes to identify inefficiencies, bottlenecks, and risks.
• Analyze customer needs, stakeholder expectations, and relevant data to understand value drivers and determine claims impacts.
• Collaborate with cross-functional partners to validate assumptions and support decision-making.
• Partner with stakeholders (Clinical, Process, IT, and operations) to align on vision, scope, and delivery of initiatives or new requirements.
• Collaborate with Process Leadership to ensure alignment on need and priority of initiatives that are being proposed.
• Translate business needs into technical impacts for the claims process.
• Ensure Compliance and Policy alignment with new opportunities and changes.

Required Qualifications

• Minimum 2 years of experience processing and/or researching claims using CAS.
• Minimum 2 years of experience leading and implementing process improvement initiatives.
• Demonstrated experience in the use of Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio.
• Demonstrated ability to analyze data, draw actionable conclusions, and make decisions.
• Experience facilitating and communicating among claims and cross-functional teams.
• Experience presenting complex concepts to peers, stakeholders, leadership, and partners.
• Experience managing multiple, diverse projects.
• Strong motivation to expand process improvement knowledge and expertise.
• Experience applying analytical and problem-solving skills.
• Experience with project and change management.

Preferred Qualifications

• Bachelor's degree.
• Previous experience with Medicaid/Medicare authorization and referral processes.

Additional Information

• Hours for this position are based on EST or CST.
• Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service 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. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• 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.

Description of Benefits

Humana, Inc. offers competitive benefits that support whole-person well-being, including medical, dental, vision, 401(k) retirement savings plan, paid time off, parental leave, and disability insurance.

Application Deadline: 07-16-2026

About Us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.

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.