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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in process improvement, business operations, and strategic program leadership, with a strong ability to manage cross-functional projects and influence stakeholders. Proficient in preparing and presenting insights and recommendations to C-suite executives while ensuring compliance with Medicaid contract requirements.
Highest-signal resume keywords
Process ImprovementCross-Functional Project LeadershipMedical Claims ProcessingStakeholder Relationship ManagementC-Suite Presentation Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Process ImprovementBusiness OperationsProgram LeadershipMedical Claims ProcessingData AnalysisWorkflow DevelopmentRisk ManagementCompliance OversightRoot Cause AnalysisDecision Making
Soft Skills
Relationship BuildingInfluencing Without AuthorityOrganizational SkillsCommunication SkillsPresentation Skills
Certifications & Qualifications
Bachelor's Degree
Industry Keywords
Medicaid ComplianceEncounter SubmissionsRegulatory ReadinessC-Suite EngagementPerformance Governance
About the role
Key responsibilities & impact- Partner with encounter leadership to set priorities, prepare decisions, and drive follow-through on strategic initiatives
- Organize priorities, meetings, decisions, owners, and timelines for complex work
- Build relationships across operations, technology, compliance, markets, vendors, providers, and regulatory partners
- Prepare and present updates, risks, options, and recommendations to C-suite executives and senior leaders
- Lead governance forums focused on performance, risks, dependencies, decisions, and regulatory readiness
- Translate encounter processes and business needs into workflows, dashboards, insights, and decision points
- Anticipate regulatory, platform, volume, and data quality risks affecting encounter submissions
- Drive cross-functional issues from root cause analysis through solution development, executive communication, and resolution
- Create and maintain Medicaid contract compliance and risk oversight processes and documentation
- Use data to challenge assumptions, recommend priorities, and improve inefficient processes
- Report to the Director, Encounter Data Management
- Occasional travel to Humana offices for training or meetings may be required
Requirements
What you’ll need- Bachelor's degree
- 5+ years of experience in process improvement, business operations, strategy, or program leadership
- 2+ years of experience leading cross-functional projects or enterprise initiatives
- 2+ years of experience processing medical claims and/or encounter submissions
- Experience organizing multiple priorities, stakeholders, decisions, and deadlines
- Experience building relationships and influencing across functions without direct authority
- Experience 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 without ongoing interruptions to protect member PHI/HIPAA information
- Not eligible for work visa sponsorship
Benefits
Comp & perks- Bonus incentive plan based upon 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
- Dedicated home workspace
- Internet service requirements/support for home work