Process Improvement Lead, Healthcare Claims

Candidates must possess a Bachelor's degree in business, operations, or a related field, with at least 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 and 2 years of demonstrated expertise in end-to-end healthcare claims operations, including claim ingestion, processing, system navigation, payment workflows, and issue resolution, are required. Strong analytical skills with experience in data analysis and process mapping tools, knowledge of change management practices, and excellent communication, facilitation, and stakeholder management skills are also necessary. Preferred qualifications include a Master's degree, Medicaid experience with provider functions, familiarity with DSNP and LTSS products, Six Sigma or Lean certification, Change Management Certification, and Humana Claims Platform/System knowledge.