Process Improvement Lead at Humana

Houston, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must have a strong understanding of business process analysis, re-engineering, and change management. A proven ability to research best business practices, analyze process data, and recommend improvements is essential. Experience with new information technologies and their application to business processes is required. Familiarity with the TRICARE program and Utilization Management activities is also necessary. The role requires independent judgment and decision-making on complex issues with minimal supervision.

Responsibilities

The Process Improvement Lead will research and benchmark business practices, analyze process data to recommend improvements, and evaluate the impact of new technologies on business processes. They will maintain knowledge of the TRICARE program, review and monitor Contract Change Orders, and collaborate with leaders to implement electronic prior authorization technology. Responsibilities also include developing process maps, offering optimization recommendations, assisting with evolving practices reports, and creating department communications. Additionally, the role involves supporting policies and procedures, ensuring reaccreditation readiness, and assisting with system testing.

Skills

Process Improvement

Business Process Analysis

Benchmarking

Change Management

Data Analysis

Business Process Re-engineering

TRICARE Program

Utilization Management

Electronic Prior Authorization Technology

Software Implementation

Project Management

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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