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The Senior Process Improvement Professional supports the analysis, design, and implementation of business process needs and improvements focused on provider data quality, claims resolution, and operational efficiency. This position evaluates process performance, identifies root causes and trends, develops metrics and reporting, and recommends solutions that improve quality, reduce risk, and support timely claim processing.
The Senior Process Improvement Professional works cross-functionally with operations, business, and technology partners to support issue resolution, process modernization, testing, and continuous improvement initiatives in alignment with TRICARE and government business requirements.
Key Responsibilities:
(25%) Analyze provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities.
(20%) Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies.
(20%) Recommend and help implement process improvements that increase efficiency, accuracy, quality, and consistency.
(15%) Develop metrics, reporting, and root cause analyses to measure performance and guide improvement efforts.
(10%) Partner with operations, process, and product teams on issue resolution, testing, automation opportunities, and process enhancements.
(5%) Support UAT, training, and communication for process and system changes.
(5%) Maintain knowledge of VA CCN requirements, provider systems, and claims operations to ensure compliant and effective process oversight.
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.
Use your skills to make an impact Required Qualifications
- 5 or more years of experience in claims operations, provider data, process improvement, or healthcare operations
- Experience developing metrics, reporting, and performance analysis to support operational improvement
- Experience analyzing business processes, identifying root causes, and recommending or implementing process improvements
- Must be self-motivated, detail oriented and able to prioritize workload
- Strong written and verbal communication skills, including the ability to present findings and recommendations to business partners and leadership
- Strong organizational skills with the ability to manage multiple priorities, meet deadlines, and work independently
- Proficiency with business systems, reporting tools, and Microsoft Office applications, especially Excel, PowerPoint, and reporting/dashboard tools used by the department
- Detail orientation and critical thinking skills with the ability to interpret data, identify trends, and resolve moderately complex operational issues
- Our Department of Defense Contract requires U.S. citizenship for this position
- Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
- HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico
Preferred Qualifications
- Bachelor’s Degree
- Strong knowledge of and/or working experience with big and complex data sets to include running queries, interpreting data with query languages SQL/PLSQL
- Knowledge of or experience working for VA or TRICARE programs
- Prior experience with Workflow design and Business Process Optimization
- Ability to learn a complex processing system
Additional Information
Work Style: Remote
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.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 10-16-2026
