Senior Process Improvement Professional

Humana Inc; Northern (KY); Hybrid; USD 78,000 - 108,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana Inc. is seeking a Senior Process Improvement Professional to analyze and improve TRICARE claims processing, partnering with the East Contract subcontractor. You will identify processes needing improvement due to initiatives, system issues, or government changes, and drive measurable benefits.

Responsibilities include data-driven analysis, benchmarking, and coordinating process changes to enhance safety, efficiency, and cost reduction while communicating with senior leadership.

Qualifications

• 5+ years of business analysis, testing or process management experience.
• Current experience understanding claims adjudication, systems and reporting.
• Strong knowledge of and/or working experience with big and complex data sets to include running queries, interpreting data with query languages SQL/PLSQL.
• Knowledge in healthcare related applications and technology.
• Ability to manage and prioritize multiple initiatives with minimal guidance.

Responsibilities

• 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.

Skills

Business analysis

Claims adjudication

SQL/PLSQL

Healthcare applications

Communication skills

Multi-tasking

Problem solving

Education

Bachelor's Degree

Tools

Excel

PowerPoint

Word

Job description

Become a part of our caring community 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

• 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

Provide business consulting to analyze and measure the effectiveness of existing business processes and develop sustainable, repeatable and quantifiable business process improvements. Research best business practices within and outside the organization to establish benchmark data. Collect and analyze process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. Determine how new information technologies can support re-engineering business processes. 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

• 5 or more years of business analysis, testing or process management experience.
• Current experience understanding claims adjudication, systems and reporting.
• Strong knowledge of and/or working experience with big and complex data sets to include running queries, interpreting data with query languages SQL/PLSQL.
• Knowledge in healthcare related applications and technology.
• Ability to manage and prioritize multiple initiatives with minimal guidance.
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership.
• Results-driven mindset with the ability to achieve established individual and organizational goals.
• Experience researching and analyzing data to determine root cause within areas of opportunity.
• Experience reading and interpreting documents such as contracts, policy and operations manuals.
• High level problem-solving and analytical experience.
• Proficiency in Microsoft office suite Excel, PowerPoint and Word.
• 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.

Preferred Qualifications

• Bachelor's Degree.
• Knowledge of Medicare and/or TRICARE.
• Previous experience managing or leading programs, technical implementations and/or initiatives.
• Prior experience with Workflow design and Business Process Optimization.
• Ability to learn a complex processing system.

Work Style: Remote Work at Home

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• many other opportunities

Application Deadline: 09-25-2026

About us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.