Senior Process Improvement Professional

Humana

4d • Remote

About The Position

Become a part of our caring community You will be focusing on provider data and claims resolution as the Senior Process Improvement Professional reporting to an Associate Director of Process Improvement. Key Accountabilities - You will implement best business practices within and outside the organization to improve data quality and efficiency. You will collect and analyze process data to develop business practices and procedures that focus on increased productivity, reduced cost, awareness and resolution provider data exposure and deficiencies. You will support daily claim deferral process, daily workflow, and operational issue resolution. You will develop metrics that provide data for process measurement and identify indicators for future improvement opportunities. You will collect data to determine root cause of problems and measure performance against process requirements and aligns improvement to performance shortfalls. You will provide consultation on the use of re-engineering techniques to improve process performance and product quality. Use your skills to make an impact

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)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 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
• 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
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours 40

Nice To Haves

• Bachelor's degree
• Knowledge of TRICARE providers
• Business analysis, project, and process management experience

Responsibilities

• implement best business practices within and outside the organization to improve data quality and efficiency
• collect and analyze process data to develop business practices and procedures that focus on increased productivity, reduced cost, awareness and resolution provider data exposure and deficiencies
• support daily claim deferral process, daily workflow, and operational issue resolution
• develop metrics that provide data for process measurement and identify indicators for future improvement opportunities
• collect data to determine root cause of problems and measure performance against process requirements and aligns improvement to performance shortfalls
• provide consultation on the use of re-engineering techniques to improve process performance and product quality

Benefits

• Humana provides 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 and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees