Senior Process Improvement Professional

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities • Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies • Recommend and help implement process improvements that increase efficiency, accuracy, quality, and consistency • Develop metrics, reporting, and root cause analyses to measure performance and guide improvement efforts • Partner with operations, process, and product teams on issue resolution, testing, automation opportunities, and process enhancements • Support user acceptance testing, training, and communication for process and system changes • Maintain knowledge of VA CCN requirements, provider systems, and claims operations • Support compliant and effective process oversight • Perform other duties and tasks requested by the supervisor consistent with company objectives • Work cross-functionally with operations, business, and technology partners on process modernization and continuous improvement initiatives aligned with TRICARE and government requirements • Occasional travel to Humana offices for training or meetings may be required

🎯 Requirements

• 5 or more years of experience in claims operations, provider data, process improvement, or healthcare operations • Experience developing metrics, reporting, and performance analysis to support operational improvement • Experience analyzing business processes, identifying root causes, and recommending or implementing process improvements • Self-motivated, detail oriented, and able to prioritize workload • Strong written and verbal communication skills • Ability to present findings and recommendations to business partners and leadership • Strong organizational skills and ability to manage multiple priorities, meet deadlines, and work independently • Proficiency with business systems, reporting tools, and Microsoft Office applications, especially Excel and PowerPoint • Proficiency with reporting/dashboard tools used by the department • Detail orientation and critical thinking skills • Ability to interpret data, identify trends, and resolve moderately complex operational issues • 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 • Strong knowledge of or working experience with big and complex data sets, including running queries and interpreting data with SQL/PLSQL • Knowledge of or experience working for VA or TRICARE programs preferred • Prior experience with workflow design and business process optimization preferred • Ability to learn a complex processing system

🏖️ 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 • Dedicated home workspace requirement to protect PHI/HIPAA information • Internet service requirements for home employees