Senior Process Improvement Professional

Humana Inc.

Job Overview

Location

Remote Nationwide

Job Type

Full-time

Full Job Description

📋 Description

• As a Senior Process Improvement Professional at Humana Inc., you will play a pivotal role in enhancing the efficiency and quality of provider data and claims resolution processes. This remote, nationwide position reports to an Associate Director of Process Improvement and is crucial for optimizing operational workflows and ensuring data integrity within a leading U.S. healthcare company.
• In this role, you will be instrumental in implementing best business practices, both internally and externally, to significantly improve data quality and operational efficiency. You will be tasked with collecting and meticulously analyzing process data to develop robust business practices and procedures. The primary focus of these initiatives will be on increasing productivity, reducing costs, and enhancing the awareness and resolution of provider data exposure and deficiencies. A key responsibility will involve supporting the daily claims deferral process, managing daily workflows, and actively participating in the resolution of operational issues. Furthermore, you will be responsible for developing key metrics that provide essential data for process measurement, identifying indicators for future improvement opportunities, and collecting data to determine the root cause of problems. Your performance will be measured against established process requirements, and you will align improvement efforts with identified performance shortfalls. You will also provide expert consultation on the application of re-engineering techniques to elevate process performance and product quality, ensuring that Humana's operations are at the forefront of industry standards.
• You will be joining a dedicated team focused on driving operational excellence within Humana, a company committed to making it easier for millions of people to achieve their best health. This role is part of a larger effort to deliver exceptional care and service to individuals across various demographics, including Medicare and Medicaid beneficiaries, families, individuals, and military service personnel. The company's mission is to improve the quality of life for those it serves through its insurance services and CenterWell healthcare services.
• This position offers a significant opportunity for professional growth and development. You will gain in-depth experience in process optimization within the complex healthcare industry, specifically focusing on claims resolution and provider data management. You will have the chance to hone your analytical and problem-solving skills, develop expertise in implementing best practices, and contribute directly to the company's mission of improving health outcomes. The role provides exposure to government contract requirements and the opportunity to work with advanced data analysis tools, fostering a comprehensive understanding of operational excellence in a regulated environment. You can achieve tangible results by driving measurable improvements in efficiency, cost reduction, and data accuracy, making a real impact on the lives of Humana's members.
• The Senior Process Improvement Professional will be responsible for identifying and implementing strategic improvements across provider data management and claims resolution. This includes developing and refining standard operating procedures, creating dashboards for performance monitoring, and collaborating with cross-functional teams to address systemic issues. You will leverage data analytics to pinpoint inefficiencies, such as claim deferrals and workflow bottlenecks, and propose data-driven solutions. Your work will directly influence the effectiveness of claims processing, ensuring timely and accurate resolutions for providers. This role requires a proactive approach to problem-solving, a deep understanding of claims operations, and the ability to translate complex data into actionable insights. By focusing on root cause analysis, you will help prevent recurring issues and foster a culture of continuous improvement. The impact of your work will be seen in enhanced operational performance, reduced financial leakage, and improved provider satisfaction, all contributing to Humana's commitment to delivering high-quality healthcare services. You will also be involved in training and mentoring other team members on process improvement methodologies, further solidifying your expertise and leadership potential within the organization. The ability to navigate and understand the nuances of TRICARE claims processing will be critical in driving targeted improvements within this specific domain, ensuring compliance and operational efficiency for a key segment of Humana's business. Your contributions will be vital in maintaining and enhancing the integrity of provider data, which is fundamental to accurate billing, reimbursement, and overall healthcare delivery. This role is an excellent opportunity for an experienced professional to make a substantial impact on a large-scale healthcare operation, driving efficiency and effectiveness through strategic process enhancements and data-driven decision-making. The remote nature of the position offers flexibility while demanding a high degree of self-discipline and effective communication to collaborate with colleagues and stakeholders across the nation. You will be at the forefront of optimizing critical business functions, ensuring that Humana can continue to provide accessible and high-quality healthcare solutions to its diverse member base. The insights you generate and the processes you refine will have a direct bearing on the company's ability to manage costs, improve service delivery, and maintain regulatory compliance in a dynamic healthcare landscape. Your role as a Senior Process Improvement Professional is not just about fixing problems; it's about building a more resilient, efficient, and effective operational framework for the future of healthcare delivery at Humana.

🎯 Requirements

• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
• 3 years of claims operations experience, including experience with professional and institutional claims.
• Experience with TRICARE claims processing and knowledge of TRICARE program.
• Experience with Excel for data analysis and creating pivot tables.
• Bachelor's degree (Preferred).
• Business analysis, project, and process management experience (Preferred).

🏖️ Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Bonus incentive plan.
• Bi-weekly internet expense reimbursement for associates in California, Illinois, Montana, or South Dakota.
• Provision of telephone equipment appropriate to meet business requirements.

Skills & Technologies

Senior

Remote

$78k-107k

Degree Required

Ready to Apply?

Apply Externally

You will be redirected to an external site to apply.

Humana Inc.

Visit Website

About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

View Company Profile

Get more remote jobs like this

Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.

Weekly remote jobs and featured talent.

No spam. Only curated remote roles and product updates. You can unsubscribe anytime.