Senior Process Improvement & Claims Quality Lead (Remote)

Humana Inc; Dover (DE); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Senior Process Improvement Professional to analyze provider data, claims processes, and develop metrics for performance improvement. This remote role supports cross-functional teams and government program requirements, including DoD contracts and NBIS clearance readiness.

You will help implement process improvements to enhance efficiency, accuracy, and quality, while maintaining knowledge of VA/TRICARE requirements and relevant provider systems.

Qualifications

• 5 or more years of experience in claims operations, provider data, process improvement, or healthcare operations.
• Experience developing metrics, reporting, and performance analysis to support operational improvement.
• Experience analyzing business processes, identifying root causes, and recommending or implementing process improvements.
• Must be self-motivated, detail oriented and able to prioritize workload.
• Strong written and verbal communication skills, including the ability to present findings and recommendations to business partners and leadership.
• Strong organizational skills with the ability to manage multiple priorities, meet deadlines, and work independently.
• Proficiency with business systems, reporting tools, and Microsoft Office applications, especially Excel, PowerPoint, and reporting/dashboard tools used by the department.
• Detail orientation and critical thinking skills with the ability to interpret data, identify trends, and resolve moderately complex operational issues.
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• 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

Responsibilities

• Analyze provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities.
• Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies.
• Recommend and help implement process improvements that increase efficiency, accuracy, quality, and consistency.
• Develop metrics, reporting, and root cause analyses to measure performance and guide improvement efforts.
• Partner with operations, process, and product teams on issue resolution, testing, automation opportunities, and process enhancements.
• Support UAT, training, and communication for process and system changes.
• Maintain knowledge of VA CCN requirements, provider systems, and claims operations to ensure compliant and effective process oversight.

Skills

Claims operations

Metrics & reporting

Process analysis

Self-motivation

Communication

Organization

Excel & BI tools

Analytical thinking

US citizenship

Security clearance

PR exclusion awareness

Education

Bachelor’s Degree

Tools

SQL/PLSQL

Job description

Humana Inc. is seeking a Senior Process Improvement Professional to analyze provider data, claims processes, and develop metrics for performance improvement. This remote role supports cross-functional teams and government program requirements, including DoD contracts and NBIS clearance readiness.

You will help implement process improvements to enhance efficiency, accuracy, and quality, while maintaining knowledge of VA/TRICARE requirements and relevant provider systems.