Senior Process Improvement Professional

🔥 9 minutes ago

🇺🇸 United States – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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 TRICARE policy and industry guidelines to create, improve and implement processes and practices affecting TRICARE claims processing • Partner with the East Contract claims processing subcontractor to oversee timely and accurate TRICARE claims processing • Gather data, apply experience, draw insights, make recommendations and influence strategy • Evaluate change by quantitatively and qualitatively measuring results against stated goals and benchmarks • Oversee improvement processes and coordinate projects and programs • Guide implementation of new and modified processes • Assist with change management to minimize disruption and maximize impact • Analyze and measure existing business-process effectiveness • Develop sustainable, repeatable and quantifiable business-process improvements • Research best practices within and outside the organization to establish benchmark data • Collect and analyze process data to recommend practices and procedures focused on enhanced safety, increased productivity and reduced cost • Determine how information technologies can support business-process re-engineering • Understand business problems and opportunities and recommend solutions supporting innovative delivery of Humana's brand and value proposition

🎯 Requirements

• 5 or more years of business analysis, testing or process management experience • Current experience understanding claims adjudication, systems and reporting • Strong knowledge of and/or working experience with big and complex data sets • Experience running queries and interpreting data with SQL/PLSQL • Knowledge in healthcare related applications and technology • Ability to manage and prioritize multiple initiatives with minimal guidance • Excellent communication and presentation skills, including communicating and presenting technical details to senior and executive leadership • Results-driven mindset with ability to achieve established individual and organizational goals • Experience researching and analyzing data to determine root cause • Experience reading and interpreting contracts, policy and operations manuals • High-level problem-solving and analytical experience • Proficiency in Microsoft Office Suite, Excel, PowerPoint and Word • U.S. citizenship required • Must successfully receive approval for government security clearance via National Background Investigation Services (NBIS) • Must not currently live in Puerto Rico • Bachelor's degree preferred • Knowledge of Medicare and/or TRICARE preferred • Previous experience managing or leading programs, technical implementations and/or initiatives preferred • Prior experience with workflow design and business process optimization preferred • Ability to learn a complex processing system preferred

🏖️ Benefits

• 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 arrangement • Dedicated home workspace requirement to protect member PHI / HIPAA information • Occasional travel to Humana offices for training or meetings may be required