Senior Process Improvement Professional

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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. You will 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:
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Analyze TRICARE policy and industry guidelines to create, improve, and implement new processes and practices that impact TRICARE claims processing.

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Gather data and apply experience to draw insights, make recommendations, and influence strategy to achieve meaningful change.

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Evaluate the effects of change by quantitatively and qualitatively measuring them against stated goals and benchmarks.

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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
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Provide business consulting to analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable and quantifiable business process improvements.

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Research best business practices within and outside the organization to establish benchmark data.

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Collect and analyze process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost.

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Determine how new information technologies can support re-engineering business processes.

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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
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5 or more years of business analysis, testing or process management experience.

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Current experience understanding claims adjudication, systems and reporting.

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Strong knowledge of and/or working experience with big and complex data sets to include running queries, interpreting data with query languages SQL/PLSQL.

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Knowledge in healthcare related applications and technology.

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Ability to manage and prioritize multiple initiatives with minimal guidance.

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Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership.

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Results-driven mindset with the ability to achieve established individual and organizational goals.

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Experience researching and analyzing data to determine root cause within areas of opportunity.

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Experience reading and interpreting documents such as contracts, policy and operations manuals.

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High level problem-solving and analytical experience.

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Proficiency in Microsoft office suite Excel, PowerPoint and Word.

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Our Department of Defense Contract requires U.S. citizenship for this position.

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Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS).

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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
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Bachelor's Degree.

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Knowledge of Medicare and/or TRICARE.

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Previous experience managing or leading programs, technical implementations and/or initiatives.

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Prior experience with Workflow design and Business Process Optimization.

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Ability to learn a complex processing system.

Additional Information

Work Style : Remote

Work at Home Requirements: To ensure Home or Hybrid H