• Job Description

  Req#: R-396599

  Become a part of our caring community and help us put health first
  

  Join Humana’s In Home Well-being Assessment (IHWA) team and play a critical role in ensuring exceptional member experience and compliance with CMS standards. As a Senior Program Delivery Professional, you will manage complex grievance and complaint processes, oversee vendor relationships, and support quality initiatives that directly impact Medicare members.

  Key Responsibilities:

  • Lead daily management of grievance and complaint queues in PPCM, ensuring timely resolution per CMS SLAs.
  • Coordinate with internal teams and external vendors to uphold best practices and contractual obligations.
  • Manage additional feedback from Stars vendors (~150 pieces weekly) as IHWA expands responsibilities in 2025–2026.
  • Support highly regulated processes, including Privacy concerns, Quality of Care issues, and MRA delete management.
  • Analyze feedback trends, communicate findings, and influence strategy for continuous improvement.

  Environment: Remote role. Operating heavily in the Patient/Provider Compliant and Management System (PPCM), managing Grievance & Appeals (G&A). Candidates must be comfortable with queue based work.

  
  Use your skills to make an impact
  

  Required Qualifications

  • Bachelor's degree or equivalent years of experience
  • 5+ years in member/provider grievance management
  • Strong knowledge of Microsoft Office (Word, Excel, Access)
  • Excellent communication, both oral and written
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

  Preferred Qualifications

  • Master's Degree in Business Administration or a related field
  • PMP certification a plus
  • Knowledge and experience in health care environment/managed care
  • Strong analytical skills

  Additional Information

  Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

  • Health benefits effective day 1

  • Paid time off, holidays, volunteer time and jury duty pay

  • Recognition pay

  • 401(k) retirement savings plan with employer match

  • Tuition assistance

  • Scholarships for eligible dependents

  • Parental and caregiver leave

  • Employee charity matching program

  • Network Resource Groups (NRGs)

  • Career development opportunities

  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.

  • Satellite, cellular and microwave connection can be used only if approved by leadership.

  • Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

  • Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

  • 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.

  
  

  $86,300 - $118,700 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: 12-11-2025

  
  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.

• About the company

  Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

Notice