About Humana


Job Category:

Business Services - Business Services


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

Process Improvement Professional 2

Humana - Work At Home, South Carolina

Posted: 11/19/2018


The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


Based on business objectives, work independently to develop an advanced knowledge of TRICARE claims processing policies, rules, and system logic.  Apply knowledge to perform analysis through data to identify, track, and resolve issues that impact timely and accurate claims processing and payment.  Utilize knowledge to directly support claims processing teams through documented work instructions and inventory management.

Develop and document system and manual processes.  Engage with operational teams to validate and improve manual processes as well as identify opportunities for automation.  Interact with internal departments as well as external sub-contractors to document, prioritize, define, and drive needed changes.  Maintain oversight of changes to system logic or operational procedures. Maintain project status updates and create reports to monitor results.  Provide status updates to management.

  • Support claims processing teams by developing and documenting business requirements, work-flows, and work instructions for operational processes and new projects/change orders.
  • Perform data analysis, interpret information, identify challenges, and formulate solutions.  Assist management with data tracking and reporting.
  • Gain and maintain proficiency in TRICARE policy, claims systems, and adjudication rules. Stay abreast of changes. Collaborates to recommend and implement process improvements for methods/techniques/analytics
  • Advises and handles escalated issues


Required Qualifications

  • Our Department of Defense contract requires U.S. Citizenship
  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)
  • 5 or more years with claims processing or related field
  • Proficient with Microsoft Office products - Word, Excel, Powerpoint and Access
  • Requires ability to understand claims adjudication, systems and reporting.
  • Ability to manage and prioritize multiple initiatives with minimal guidance.          
  • Excellent written and verbal communication skills and strong customer service skills         
  • Ability to take initiative and meet objectives
  • High level of problem-solving and analytical skills

  • Ability to read and interpret documents such as contracts and operations manuals

Preferred Qualifications

  • Bachelor's degree
  • Highly desired to have previous TRICARE claims experience
  • Medicare claims experience

Scheduled Weekly Hours


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