Process Improvement Professional

$63,400 - $87,400/Yr

Humana - Boston, MA

Full-time - Mid Level

Hybrid - Boston, MA

Insurance Carriers and Related Activities

About the position

The Process Improvement Professional at Humana plays a crucial role in enhancing the efficiency of business processes within the Wisconsin Medicaid market. This position involves analyzing current processes, developing improvements, and ensuring compliance with regulatory requirements. The professional will collaborate with various teams to establish effective procedures and support operations management in achieving operational excellence.

Responsibilities

• Analyze and measure the effectiveness of existing business processes.
• Develop and maintain user-friendly formalized Intradepartmental Desk Procedures (IDPs) for Operations-related functions.
• Communicate departmental changes to policies and procedures to Operations staff.
• Collaborate with non-Operations i Care staff to understand new products and processes.
• Assist Operations staff with daily claims, enrollment, and provider services issues.
• Research benefits issues using available resources.
• Identify and research new processing issues and update IDPs as necessary.
• Establish audit procedures and perform audits to analyze Operations staff performance.
• Conduct periodic audits of claims processing vendor's performance and provide analysis.
• Assist with government audits to comply with regulatory requirements.
• Coordinate the configuration process for system changes and verify accuracy.
• Participate in Operations-related projects and initiatives.

Requirements

• Minimum of three (3) years' experience in health insurance or managed care operations.
• Experience in problem definition, data collection, and analysis.
• Experience in preparing business documents and reporting analysis findings.
• Experience utilizing research tools for business measures.

Nice-to-haves

• 3 years of documentation, audit, and analysis experience in a managed care or health insurance environment.
• A degree in business or a related field.

Benefits

• Health benefits effective day 1
• Paid time off, holidays, volunteer time, and jury duty pay
• Recognition pay
• 401(k) retirement savings plan with employer match
• Tuition assistance
• Scholarships for eligible dependents
• Parental and caregiver leave
• Employee charity matching program
• Network Resource Groups (NRGs)
• Career development opportunities