Senior Process Improvement Professional

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

📋 Description

• Evaluate and assess the effectiveness of current business processes.

• Create sustainable, repeatable, and measurable enhancements to business processes.

• Manage the timely and precise processing of TRICARE claims in collaboration with the East Contract claims processing subcontractor.

• Analyze and pinpoint claims processes that need improvement due to business initiatives, system challenges, or mandated changes from the government.

• Review TRICARE policy and industry standards to develop, refine, and execute processes and practices that impact claims processing.

• Collect data, derive insights, formulate recommendations, and influence strategic direction.

• Assess changes through both quantitative and qualitative metrics against objectives and benchmarks.

• Coordinate projects and programs for the implementation of new or revised processes.

• Support change management efforts to reduce disruption and enhance impact.

• Investigate best practices and establish benchmark data.

• Gather and analyze process data to propose practices aimed at safety, productivity, and cost-efficiency.

• Identify how new information technologies can facilitate business process re-engineering.

• Comprehend business challenges and opportunities, recommending solutions that align with Humana's brand and value proposition.

⛳️ Requirements

• At least 5 years of experience in business analysis, testing, or process management.

• Current knowledge of claims adjudication, systems, and reporting.

• Strong understanding and/or experience with large and complex data sets.

• Proficient in executing queries and interpreting data using SQL/PLSQL.

• Familiarity with healthcare-related applications and technologies.

• Ability to manage and prioritize various initiatives with minimal supervision.

• Exceptional communication and presentation skills, including the capability to convey technical details to senior and executive leadership.

• Results-oriented mindset with the ability to meet individual and organizational goals.

• Experience in researching and analyzing data to identify root causes.

• Ability to read and interpret contracts, policy documents, and operations manuals.

• High-level problem-solving and analytical skills.

• Proficient in Microsoft Office Suite, including Excel, PowerPoint, and Word.

• U.S. citizenship is required.

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

• Candidates must not currently reside in Puerto Rico.

• A Bachelor's Degree is preferred.

• Knowledge of Medicare and/or TRICARE is preferred.

• Previous experience in managing or leading programs, technical implementations, and/or initiatives is preferred.

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

• Ability to quickly learn a complex processing system is preferred.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Home-based remote work options.

• Occasional travel to Humana offices for training or meetings.

• Dedicated home workspace support for safeguarding PHI/HIPAA information.

• Internet service requirements/support for remote work.