Business Consultant - Claims Operations Oversight

5 - 7 years experience  •  Misc. Healthcare

Salary depends on experience
Posted on 11/20/17
Louisville, KY
5 - 7 years experience
Misc. Healthcare
Salary depends on experience
Posted on 11/20/17

In the fast-paced, ever-growing world of Healthcare, Humana relies on the latest technology and trends for sharing and storing information, communication and security. We need experts in technology to help us develop and maintain our networks, hardware, and software—to ensure our systems run smoothly and efficiently, keep us on the forefront of innovation in healthcare, and retain our competitive edge. At Humana, we want to help people everywhere, including our associates lead their best lives and achieve lifelong well-being. We look for talented individuals who share this passion for helping others, who have naturally curious and innovative minds, and who want a career where they can use their technical skills to make a positive impact on the lives of our members.   Assignment Capsule The Claims Oversight Business Consultant for Humana Government Business will  provide business consulting to effectively implement change and proactively identify and manage business process improvement opportunities. Leveraging the work of business analysts, lead and participate in efforts to design innovative and strategic business processes that maximize solutions, create sustainable competitive advantage and deliver administrative efficiencies. Provide project and program coordination to guide the implementation of new processes and process modification and assist with change management to minimize disruption and maximize impact. The Business Consultant understands requirements in the broadest context of business problems and opportunities, and recommends solutions that enable innovative delivery of Humana’s brand and value proposition. Our Department of Defense Contract requires U.S. citizenship for this position.   Scope of Role and Responsibilities: 

  • As a Claims Oversight Business Consultant you will be a part of a team which analyzes and identifies key claims processes that need to be improved – either due a business initiative, system issue, or government directed change.
  • Analyze TRICARE policy and industry guidelines to create, improve, and implement new processes and practices that impact TRICARE claims processing. Evaluate the effects of change by quantitatively and qualitatively measuring them against internal and external benchmarks.
  • Use a working knowledge of available information to integrate, analyze, and present data in a clear manner. Draws insights from data and tells the story of what the information means in order to inform decisions and actions. Oversee the improvement process.
  • Be a business owner of claims functionality and promote the implementation of best practices.


  • Proactively identifies improvement opportunities as well as providing subject matter expertise and analysis to issues, changes, and improvements based on industry and competitive trends and analysis of current processes and barriers.
  • Leads the documentation of business needs for innovative business processes that support Claims Oversight solutions, create sustainable competitive advantage and administrative efficiencies.
  • Utilizes project management principles to oversee project and program implementation efforts to ensure expected results are achieved.
  • Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and role essentials.
  • Assures process documentation meets current and future requirements and supports the successful implementation of business innovation.
  • Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description.  The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.    Role Essentials

  • Bachelor’s Degree or equivalent education and/or experience
  • Five years of business analysis, project, and process management experience
  • Knowledge in healthcare related business applications and technology.
  • Ability to understand claims adjudication, systems and reporting
  • Ability to manage and prioritize multiple initiatives with minimal guidance
  • Must be able to promote teamwork and build effective relationships while meeting objectives.               
  • Ability to take initiative and meet objectives
  • High level of problem-solving and analytical skills.
  • Read and interpret documents such as contracts and operations manuals
  • Prior demonstrated experience with process improvement or process design and implementation roles
  • Working knowledge of claims processing systems and medical claims data
  • Working knowledge of all Microsoft Office applications, including Word, Visio, Excel and Access
  • Strong consultative skills and relationship building skills
  • Excellent written and verbal communication skills
  • Excellent planning and organizational skills
  • Ability to work on multiple projects
  • Ability to successfully handle change in a fast paced environment

  Role Desirables

  • PMP, CBAP, or CCP certification
  • Requires Medicare or TRICARE knowledge



Reporting Relationships

  • You will report to a Department Manager.

Additional Information   At Humana, we know your well-being is important to you, and it’s important to us too.  That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life.  If you share our passion for helping people, we likely have the right place for you at Humana


Not the right job?
Join Ladders to find it.
With a free Ladders account, you can find the best jobs for you and be found by over 20,0000 recruiters.