[Hiring] Senior Process Improvement Professional @Humana

Role Description

You will be focusing on provider data and claims resolution as the Senior Process Improvement Professional reporting to an Associate Director of Process Improvement.

• 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 of 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, aligning improvement to performance shortfalls.
• Provide consultation on the use of re-engineering techniques to improve process performance and product quality.

Qualifications

• U.S. citizenship required for this position due to Department of Defense Contract.
• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service).
• 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.

Requirements

• Bachelor's degree (preferred).
• Knowledge of TRICARE providers (preferred).
• Business analysis, project, and process management experience (preferred).
• 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.
• 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Competitive benefits that support whole-person well-being.
• 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.

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 based upon company and/or individual performance.

Application Deadline

04-10-2026

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.