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 t