Senior Process Improvement Professional/HGB TRICARE Benefits Claims processing exp. Remote Nationwide

Profile

Job Information

Humana

Senior Process Improvement Professional/HGB (TRICARE Benefits, Claims processing exp.) Remote Nationwide

in

Pittsburgh

Pennsylvania

Description

The Senior Process Improvement Professional analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

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 role 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

40%

Proactively identifies improvement opportunities based on trends and analysis of current processes and barriers for claims, system support and quality

Ensure the appropriate identification of root causes through effective use of data analysis tools and techniques, analyze data to make informed decisions

Collect, validate, and disseminate detailed accurate information to key stakeholders (internal and external) to successfully implement changes and improve customer satisfaction

Provides and shares analysis for improvement efforts. Prepares plan for deployment

40%

Assures process documentation meets current and future requirements and responsible for the successful implementation of projects

Map current processes, assess change required and implement accurately

Test and validate system changes to assure expected results are achieved

20%

Meets established expectations and takes responsibility for achieving results; encourages others to do the same

Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and role essentials

Leads the design of innovative business processes that support Information Technology solutions, create sustainable competitive advantage and administrative efficiencies.

Provides assistance to less experienced analysts on process models to disseminate learning and promote the development of others.

Extends professional knowledge and develops skills through departmental training and self-motivated opportunities.

Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions

Required Qualifications

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

Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

3 years TRICARE benefits and/or claims processing experience (Researching claims payment issues or implementing system changes?

Advanced knowledge of Microsoft Office products

Ability to learn a complex processing system

Ability to manage and prioritize multiple initiatives with little guidance

Requires ability to understand policies and procedures for claims adjudication, system support and reporting

Requires a high level of problem-solving and analytical skills

Ability to read and interpret documents such as contracts, policy and operations manuals

Experience in process improvement projects

Requires effective written and verbal communication skills, presentation skills and strong customer service skills

Work at Home/Remote Requirements

: Must ensure designated work area is free from distractions during work hours and virtual meetings. Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Bachelor's Degree

Workflow design and Business Process Optimization

SQL and Visio

PMP, Six Sigma, or CCP certification

Additional Information

Schedule:

Monday to Friday from 8 am to 5 pm. We do have flex opportunities that allow associates to work 4, 10 hour shifts but they must be scheduled and approved by management.

Training:

We do not have a formal training program. Prior TRICARE experience is required and preferably system change experience. The training will be conducted within the team. The associate will have a Peer Coach.

Work Location (Address): Remote Nationwide

% Travel

: Less than 10% when required

COVID VACCINATION

: We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve. If progressed to offer, you will be required to provide proof of full vaccination where allowed by law. Medical and religious exemptions will be considered on a case-by-case basis.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com