Sr. Program Delivery Professional, G&A

Senior Program Delivery Professional

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 20252026.
• 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 :

Preferred Qualifications :

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 securityboth today and in the future, including :

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 :

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.

Humana, Inc. 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services.