Authorization and Referral Claims Process Improvement Lead

** Become a part of our caring community*
* The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Process Improvement Lead will work closely with the Authorization and Referral Process team on large scale initiatives and new concepts to help translate business need into technical requirements.

Key Responsibilities include:

+ Partner with business leaders, teams, and cross-functional groups to Lead process analysis and root cause

+ Facilitate workshops, working sessions, and improvement events

+ Communicate progress, risks, and outcomes to leadership

+ Analyze operational data to identify trends and improvement opportunities

+ Build reports/dashboards to monitor improvements and define KPIs and metrics to measure process performance

+ Ensure processes are scalable, repeatable, and compliant

+ Evaluate current business processes to identify inefficiencies, bottlenecks, and risks

+ Analyze customer needs, stakeholder expectations, and relevant data to understand value drivers and determine claims impacts

+ Collaborate with cross-functional partners to validate assumptions and support decision-making.

+ Partner with stakeholders (Clinical, Process, IT, and operations) to align on vision, scope, and delivery of initiatives or new requirements.

+ Collaborate with Process Leadership to ensure alignment on need and priority of initiatives that are being purposed

+ Translate business needs in technical impacts for claims process

+ Ensure Compliance and Policy alignment with new opportunities and changes

** Use your skills to make an impact*
* ** Required Qualifications*
* +  
** Minimum 2 years of experience processing and/or researching claims using CAS*
* +  
** Minimum 2 years of experience leading and implementing process improvement initiatives*
* + Demonstrated experience the use of Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio

+  
** Demonstrated ability to analyze data and draw actionable conclusions and make decisions*
* + Experience facilitating and communicating among claims and cross functional teams.

+  
** Experience presenting complex concepts to peers, stakeholders, leadership, and partners*
* +  
** Experience managing multiple, diverse projects*
* +  
** Strong motivation to expand process improvement knowledge and expertise*
* + Experience applying analytical and problem-solving skills

+

Experience with project and change management

** Preferred Qualifications*
* + Bachelor's degree

+  
** Previous experience with Medicaid/Medicare authorization and referral processes*
* ** Additional Information*
* + Hours for this position are based on EST or CST.

Work at Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

** Scheduled Weekly Hours*
* 40

** Pay Range*
* The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or…