Senior Process Improvement Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must have a minimum of 2 years of experience in process improvement, implementation, or project management. They should possess excellent organizational and project management skills, with a strong attention to detail. The role requires the ability to manage multiple tasks, priorities, and deadlines effectively, along with an understanding of state and regulatory compliance. Proficiency in Microsoft applications like Word, Excel, PowerPoint, and Lucid is essential. Preferred qualifications include a minimum of 1 year of experience with medical claims payment and processing, and knowledge of healthcare industry regulations. Experience creating pivot tables and consumable information within Excel is also preferred.

Responsibilities

The Senior Process Improvement Professional will analyze and measure the effectiveness of existing business processes, developing sustainable and quantifiable improvements. They will partner with multiple teams to execute state implementations, solve business issues related to DSNP encounter submissions and payments, and create process flows and policy/procedure documents. Responsibilities include enhancing business processes, identifying opportunities, interpreting data, producing recommendations, and tracking plans to completion. The role involves developing and maintaining reporting mechanisms, leading project completion through collaboration, and designing end-to-end process flows with technical architecture. Additionally, they will communicate and present effectively, own daily operating objectives, and report on key performance metrics.

Skills

Process Improvement

Business Process Analysis

Data Management

Healthcare Quality Reporting

Policy Development

Procedure Writing

Project Management

Data Analysis

Reporting

Trend Analysis

Metrics Tracking

Collaboration

Communication

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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