Director, Process Improvement

Humana

19h • $150,000 - $206,300 • Remote

About The Position

As a remote Director, Process Improvement, you will report to an Associate VP of Strategy Advancement. You will drive ecosystem strategy, identifying architecture simplifications, provider data quality improvements, operational and quality automations. You will deliver end to end efficiency, quality and modernization through automations, operational processes and product technology strategies. You will manage provider data business intelligence, including business case and value for supporting efficiency opportunities and ongoing processes improvements across manual and automated provider operations. You will partner across Humana Military products, IT, automation teams and business partners on data stewardship and data models. You will initiate strategies to leverage new technologies to improve provider data quality and reduced manual touch (AI, BOTs). You will manage UAT processes and automations, including pre and post deployment testing across product and operations teams. You will ensure quality programs monitor adherence to TRICARE policies. You will monitor provider data incident, escalation and resolution processes identifying key trends and iterative solution strategies. You will monitor Claim Deferral inventories ensuring provider related claim dependencies are resolved timely.

Requirements

• U.S. Citizenship
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
• 7 years in leadership experience over a large operations area
• 7 years direct experience in health plan operations: contract management, claims processing or provider data management
• 7 years experience in data analysis and/or metrics reporting or auditing for quality
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Bachelor's degree
• Experience and proficiency with TRICARE operations policy
• Proficiency in SQL data queries and reporting

Responsibilities

• Drive ecosystem strategy, identifying architecture simplifications, provider data quality improvements, operational and quality automations
• Deliver end to end efficiency, quality and modernization through automations, operational processes and product technology strategies
• Manage provider data business intelligence, including business case and value for supporting efficiency opportunities and ongoing processes improvements across manual and automated provider operations
• Partner across Humana Military products, IT, automation teams and business partners on data stewardship and data models
• Initiate strategies to leverage new technologies to improve provider data quality and reduced manual touch (AI, BOTs)
• Manage UAT processes and automations, including pre and post deployment testing across product and operations teams
• Ensure quality programs monitor adherence to TRICARE policies
• Monitor provider data incident, escalation and resolution processes identifying key trends and iterative solution strategies
• Monitor Claim Deferral inventories ensuring provider related claim dependencies are resolved timely

Benefits

• medical
• dental
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Director