Senior Process Improvement Professional

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate provider data and claims-related processes to uncover gaps, risks, trends, and opportunities for improvement.

• Assist with daily claim deferrals, workflow management, and resolving operational issues associated with provider data dependencies.

• Propose and aid in the execution of process enhancements that boost efficiency, accuracy, quality, and consistency.

• Create metrics, reports, and root cause analyses to assess performance and direct improvement initiatives.

• Collaborate with operations, process, and product teams on issue resolution, testing, automation possibilities, and process advancements.

• Facilitate user acceptance testing, training, and communication regarding process and system modifications.

• Stay informed about VA CCN requirements, provider systems, and claims operations.

• Ensure compliant and effective process oversight.

• Perform additional duties and tasks as requested by the supervisor in alignment with company goals.

• Work collaboratively across functions with operations, business, and technology partners on process modernization and continuous improvement efforts in line with TRICARE and government regulations.

• Occasional travel to Humana offices for training or meetings may be necessary.

⛳️ Requirements

• A minimum of 5 years of experience in claims operations, provider data, process improvement, or healthcare operations.

• Experience in developing metrics, reports, and performance analysis to facilitate operational improvements.

• Proven ability to analyze business processes, identify root causes, and suggest or implement process enhancements.

• Self-driven, detail-oriented, and capable of prioritizing workload effectively.

• Exceptional written and verbal communication skills.

• Capability to present findings and recommendations to business partners and leadership.

• Strong organizational skills with the ability to manage multiple priorities, adhere to deadlines, and work independently.

• Proficiency in business systems, reporting tools, and Microsoft Office applications, particularly Excel and PowerPoint.

• Familiarity with reporting/dashboard tools utilized by the department.

• Detail-oriented with strong critical thinking abilities.

• Ability to analyze data, identify trends, and resolve moderately complex operational challenges.

• U.S. citizenship is required.

• Must successfully obtain approval for government security clearance through the National Background Investigation Services (NBIS).

• Must not currently reside in Puerto Rico.

• A Bachelor’s Degree is preferred.

• Strong understanding of or experience with large and complex data sets, including executing queries and interpreting data using SQL/PLSQL.

• Knowledge of or experience with VA or TRICARE programs is preferred.

• Previous experience in workflow design and business process optimization is preferred.

• Willingness to learn a complex processing system.

🏝️ Benefits

• Bonus incentive plan based on 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 options.

• Requirement for a dedicated home workspace to protect PHI/HIPAA information.

• Internet service requirements for remote employees.