Humana

Process Improvement Lead, Healthcare

San Antonio, Texas, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree in business, Operations, or a related field, with over 5 years of experience in healthcare process improvement, project management, or operations, preferably within the Medicaid sector. A minimum of 5 years of experience in the healthcare industry is required, along with demonstrated ability to lead cross-functional teams and manage multiple priorities. Strong analytical skills, experience with data analysis and process mapping tools like Power BI, and knowledge of change management practices are essential. Preferred qualifications include a Master's degree, Medicaid experience with provider functions, DSNP and LTSS product knowledge, and Six Sigma, Lean, or Change Management certification.

Responsibilities

The Process Improvement Lead will identify, analyze, and implement strategies to enhance operational efficiency, service quality, and overall performance within enterprise shared service and National Medicaid Operations functions. Responsibilities include designing and leading process improvement initiatives from assessment to implementation, facilitating workshops to resolve issues and map processes, analyzing workflows to identify inefficiencies, and recommending data-driven solutions. The role involves partnering with business units to standardize, optimize, and automate processes, defining and monitoring key performance indicators, developing business cases and project plans, and building a culture of continuous improvement through coaching and training. Additionally, the lead will present findings to senior leadership and ensure alignment of improvement efforts with organizational goals, compliance, and quality standards.

Skills

Process Improvement
Healthcare Claims
Operational Excellence
Workflow Analysis
Data-Driven Solutions
KPI Monitoring
Business Case Development
Project Planning
Cross-functional Collaboration

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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