Authorization and Referral Claims Process Improvement Lead

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🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $94.9k - $130.5k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Analyze and measure the effectiveness of existing business processes • Work closely with the Authorization and Referral Process team on large scale initiatives • Partner with business leaders 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 • Ensure processes are scalable, repeatable, and compliant • Evaluate current business processes to identify inefficiencies, bottlenecks, and risks • Collaborate with stakeholders to support decision-making

🎯 Requirements

• 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 using Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio • Demonstrated ability to analyze data and draw actionable conclusions • Experience facilitating and communicating among claims and cross-functional teams • Strong motivation to expand process improvement knowledge and expertise • Experience applying analytical and problem-solving skills • Experience with project and change management • Bachelor's degree preferred

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities