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The Senior Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements.
Claims Oversight Senior Process Improvement Professionals are part of a team responsible for oversight of timely and accurate processing of TRICARE claims. This is achieved through partnership with the East Contract claims processing subcontractor. The position includes direct engagement to analyze and identify key claims processes that need to be improved - either due a business initiative, system issue, or government directed change.
Daily activities include:
Analyze TRICARE policy and industry guidelines to create, improve, and implement new processes and practices that impact TRICARE claims processing.
Gather data and apply experience to draw insights, make recommendations, and influence strategy to achieve meaningful change.
Evaluate the effects of change by quantitatively and qualitatively measuring them against stated goals and benchmarks.
Oversee the improvement process. Provide project and program coordination to guide the implementation of new processes and process modification and assist with change management to minimize disruption and maximize impact.
KEY ACCOUNTABILITIES
Provide business consulting to analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable and quantifiable business process improvements.
Research best business practices within and outside the organization to establish benchmark data.
Collect and analyze process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost.
Determine how new information technologies can support re-engineering business processes.
Understand requirements in the broadest @context of business problems and opportunities and recommend solutions that enable innovative delivery of Humana's brand and value proposition.
Use your skills to make an impact
Required Qualifications
5 or more years of business analysis, testing or process management experience
Current experience with understanding claims adjudication, systems and reporting
Strong knowledge of and/or working experience with big and complex data sets to include running queries, interpreting data with query languages SQL/PLSQL
Knowledge in healthcare related applications and technology
Ability to manage and prioritize multiple initiatives with minimal guidance
Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
Results-driven mindset with the ability to achieve established individual and organizational goals.
Experienced in researching and analyzing data to determine root cause within areas of opportunity
Experience reading and interpreting documents such as contracts, policy and operations manuals
High level problem-solving and analytical experience
Proficiency in Microsoft office suite Excel, PowerPoint and Word
Our Department of Defense Contract requires U.S. citizenship for this position
Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
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
Preferred Qualifications
Bachelor's Degree
Knowledge of Medicare and/or TRICARE
Previous experience managing or leading programs, technical implementations and/or initiatives
Prior experience with Workflow design and Business Process Optimization
Ability to learn a complex processing system
Additional Information
Work Style : Remote
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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
40
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.
$78,400 - $107,800 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 10-16-2026
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.
