Director, Process Improvement

Humana • Trenton, NJ • 2h ago

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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

Use your skills to make an impact

Required Qualifications

Our Department of Defense contract requires U.S. Citizenship

Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)

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.

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

Preferred Qualifications

Bachelor's degree

Experience and proficiency with TRICARE operations policy

Proficiency in SQL data queries and reporting

Work at Home Requirements

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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$150,000 - $206,300 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.

Application Deadline: 05-28-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at?Humana.com?and at?CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Humana

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