VP, Claims Process & Operations

Kentucky, United States

Apply with AI Apply

Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree, preferably in a business-related field, and have 8+ years of management experience leading large teams in an operations environment within a large corporation. A minimum of 5 years of healthcare/managed care industry experience is required, along with a proven ability to excel in dynamic, fast-paced environments. Strong computer skills and prior leadership experience in driving process improvement, leveraging data and analytics, and ensuring regulatory compliance are essential. The ability to build high-performing teams by identifying, cultivating, and motivating top talent is also sought.

Responsibilities

The VP, Claims Process & Operations will lead the day-to-day execution of a large-scale operations team and oversee the modernization of enterprise claims operations. This role involves leading the design and implementation of new claims processes to support business growth and modernize operating platforms. Responsibilities include acting as the horizontal leader for claims, developing and executing strategies in partnership with stakeholders to improve customer experiences and business results, and driving outcomes across customer experience, compliance, financial performance, and associate experience. The position requires a process mindset to navigate complex business operations and systems.

Skills

Claims Processing

Operations Management

Budget Management

Team Leadership

Process Improvement

Healthcare

Medicare

Medicaid

Regulatory Compliance

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.

Land your dream remote job 3x faster with AI

Try Jobo Free