VP, Claims Process & Operations

About Humana

• Employment Type: Full time
• Humana is a $100+ billion (Fortune 38) market leader in integrated healthcare.
• Our purpose is to help people achieve lifelong well-being.
• We are committed to advancing the employment experience and vitality of our associate community.
• We embrace a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

About the Role

• We are seeking an accomplished executive to join our team and lead our claims horizontal.
• The VP, Claims Process & Operations will play an essential strategic and operational role in delivering Humana’s value proposition to our customers.
• This role supports Humana’s customer growth, retention, and satisfaction.
• The Claims Operations team ensures Humana’s 9+ million Medicare and Medicaid members receive access to care and that claim payments are accurate and timely.
• The work is critical to our compliance with industry regulations and to numerous downstream processes.
• Operational savviness is key to the success of this role.
• The team consists of 1,200+ Claims Operations associates, supported by external partners.
• They ensure the highest operational standards for more than 240M claims processing transactions associated with our 9+ million members.
• Reporting to the Senior Vice President of Claims Administration and Payment Integrity (CAPI).
• This leader will manage a $132M+ operating budget with 4 direct reports.
• Applicants living in Central or Eastern time zones are preferred.

Key Responsibilities

• Responsible for leading the day-to-day execution of a large-scale operations team.
• Leading modernization of enterprise claims operations.
• Lead the design and implementation of new claims processes to support our growing business and modernize our enterprise claims operating platforms.
• Act as the horizontal leader for claims.
• Strategy development and execution: Partner with internal and external stakeholders to develop and deliver solutions that improve customer experiences and business results.
• Results orientation: Drive for outcomes that are balanced across multiple dimensions (customer experience, compliance, financial, associate experience, etc.).
• Process mindset: Ability to navigate business operations with complex processes and systems.
• Use your skills to make an impact.

Key Candidate Qualifications

• The successful candidate will bring deep expertise in claims operations, strong leadership capabilities, and a track record of transforming complex processes through technology, analytics, and innovation.
• Possessing deep experience in the end-to-end claims lifecycle, overseeing the strategic direction, operational efficiency, and performance of the claims functions.
• This will allow the leader to ensure timely, accurate, and customer-focused claims processing, while driving continuous improvement, regulatory compliance, and cost-effective operations.

Professional Qualifications and Personal Attributes

• Bachelor’s degree, preferably in a business-related field.
• 8+ or more years of management experience (leading a large team within an operations environment at a large corporation).
• 5 or more years of healthcare/managed care industry experience.
• Proven ability to excel in a dynamic, changing, and fast-paced environment.
• Prior leadership experience driving process improvement, leveraging data and analytics, and ensuring regulatory compliance.
• Proven ability to build high-performing teams by identifying, cultivating, and motivating top talent from inside and outside of the organization.
• Strong computer skills.