Senior Process Improvement Professional

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

📋 Description

• Evaluate TRICARE policies and industry standards to develop, enhance, and execute processes and practices that impact TRICARE claims processing.

• Collaborate with the East Contract claims processing subcontractor to ensure timely and precise TRICARE claims processing.

• Collect data, leverage experience, extract insights, provide recommendations, and shape strategy.

• Assess changes by quantitatively and qualitatively evaluating outcomes against set objectives and benchmarks.

• Supervise improvement initiatives and orchestrate projects and programs.

• Direct the implementation of new and revised processes.

• Support change management efforts to minimize disruption and maximize effectiveness.

• Analyze and assess the efficiency of current business processes.

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

• Investigate best practices both within the organization and externally to establish benchmark data.

• Collect and assess process data to propose practices and procedures that enhance safety, boost productivity, and lower costs.

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

• Comprehend business challenges and opportunities, while recommending solutions that promote innovative delivery of Humana's brand and value proposition.

⛳️ Requirements

• A minimum of 5 years of experience in business analysis, testing, or process management.

• Recent experience in understanding claims adjudication, systems, and reporting.

• Strong knowledge of and/or practical experience with large and complex data sets.

• Proficiency in running queries and interpreting data using SQL/PLSQL.

• Familiarity with healthcare-related applications and technology.

• Ability to manage and prioritize multiple projects with minimal oversight.

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

• A results-oriented mindset with the capability to meet established individual and organizational goals.

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

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

• High-level problem-solving and analytical skills.

• Competence 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 with workflow design and business process optimization is preferred.

• An aptitude for learning a complex processing system is preferred.

🏝️ 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 arrangement.

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

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