Humana
Humana
Humana is a healthcare and health insurance company focused on improving health outcomes for individuals, communities, and the broader healthcare system. Its work includes Medicare Advantage HMO, PPO, and PFFS plans serving populations such as seniors and military members. Humana also emphasizes an inclusive workplace built around belonging, mutual respect, and opportunities for employees to contribute to the company’s health-focused mission.

Senior Process Improvement Professional at Humana — U.S. Remote

Humana is hiring a senior process improvement professional to improve provider data quality and claims operations in a U.S. remote role. The work includes process analysis, performance reporting, issue resolution, modernization, and operational support.

Description

  • Examine provider data and claims processes for gaps, risks, trends, and improvement opportunities
  • Manage daily claim deferrals, workflows, and operational issues involving provider data dependencies
  • Recommend and implement improvements that strengthen efficiency, accuracy, quality, and consistency
  • Create metrics, reports, and root cause analyses to evaluate performance and direct improvement work
  • Collaborate with operations, process, and product teams on issue resolution, testing, automation, and process enhancements
  • Support user acceptance testing, training, and communications related to process and system changes
  • Keep current on VA CCN requirements, provider systems, and claims operations
  • Help maintain compliant, effective process oversight
  • Complete additional duties assigned by the supervisor in support of company objectives
  • Work with operations, business, and technology partners on modernization and continuous improvement initiatives supporting TRICARE and government requirements
  • Travel occasionally to Humana offices for training or meetings as needed

Requirements

  • At least five years of experience in claims operations, provider data, process improvement, or healthcare operations
  • Experience creating metrics, reports, and performance analyses for operational improvement
  • Experience evaluating business processes, determining root causes, and recommending or implementing improvements
  • Self-directed, detail-oriented, and capable of prioritizing workload
  • Strong written and verbal communication abilities
  • Able to present findings and recommendations to business partners and leaders
  • Strong organizational skills with the ability to manage competing priorities, meet deadlines, and work independently
  • Proficiency with business systems, reporting tools, and Microsoft Office, particularly Excel and PowerPoint
  • Proficiency with the reporting and dashboard tools used by the department
  • Strong attention to detail and critical thinking skills
  • Able to interpret data, recognize trends, and resolve moderately complex operational issues
  • U.S. citizenship is required
  • Must obtain approval for government security clearance through National Background Investigation Services (NBIS)
  • Must not currently reside in Puerto Rico
  • Bachelor’s degree preferred
  • Strong knowledge of or experience working with large, complex datasets, including querying and interpreting data with SQL or PL/SQL
  • Knowledge of or experience with VA or TRICARE programs preferred
  • Prior workflow design and business process optimization experience preferred
  • Able to learn a complex processing system

Benefits

  • Bonus incentive plan tied to company and/or individual performance
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • 401(k) retirement savings plan
  • Paid time off
  • Company holidays
  • Personal holidays
  • Paid parental leave
  • Paid caregiver leave
  • Short-term disability coverage
  • Long-term disability coverage
  • Life insurance
  • Remote work arrangement
  • Dedicated home workspace required to protect PHI and HIPAA information
  • Internet service requirements for home-based employees

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