Remote Senior Claims Process Improvement Lead

Humana; United States; Remote; USD 78,000 - 108,000; Full time

Job summary

Humana is seeking a Senior Process Improvement Professional to analyze and improve TRICARE claims processing and to partner with the East Contract claims processing subcontractor.

You will gather data, measure impact, and guide the implementation of new processes while minimizing disruption and maximizing efficiency. This remote role requires strong analytical skills, healthcare knowledge, and the ability to communicate complex technical details to senior leadership.

Qualifications

• 5+ years of business analysis, testing or process management experience.
• Experience with claims adjudication, systems and reporting.
• Knowledge of large, complex data sets and SQL/PLSQL.
• Healthcare applications and technology knowledge.
• Ability to manage multiple initiatives with minimal guidance.
• Excellent communication and presentation skills with senior leadership.
• Experience researching and analyzing data to determine root causes.
• Experience reading contracts, policies and operations manuals.
• Strong problem-solving and analytical skills.
• Proficiency with MS Office (Excel, PowerPoint, Word).
• U.S. citizenship required for DoD contract; NBIS security clearance.
• Not authorized to hire in Puerto Rico per government contract.

Responsibilities

• Analyze TRICARE policy and industry guidelines to create, improve, and implement processes affecting TRICARE claims processing.
• Gather data and draw insights to influence strategy and achieve change.
• Evaluate the effects of change by measuring against goals and benchmarks.
• Oversee the improvement process and coordinate projects, guiding implementation and change management to minimize disruption.

Skills

Business analysis

Data analysis

SQL/PLSQL

Communication

Change management

Project coordination

Healthcare knowledge

Microsoft Office

Education

Bachelor's Degree

Tools

Microsoft Excel

PowerPoint

Word

Job description

Humana is seeking a Senior Process Improvement Professional to analyze and improve TRICARE claims processing and to partner with the East Contract claims processing subcontractor.

You will gather data, measure impact, and guide the implementation of new processes while minimizing disruption and maximizing efficiency. This remote role requires strong analytical skills, healthcare knowledge, and the ability to communicate complex technical details to senior leadership.