Humana · 8 hours ago
Director Process Improvement
United States
Full-time
Remote
Mid, Senior Level
$150K/yr - $206K/yr
5+ years expHumana is committed to putting health first and is seeking a Director of Process Improvement to manage claims processing operations. This role will oversee vendor management and ensure compliance with regulatory standards while optimizing operational efficiency.
Health CareHealth InsuranceInsuranceVenture Capital
No H1B
Security Clearance RequiredU.S. Citizen Only
Responsibilities
Oversee claims processing activities performed by external vendors, ensuring accuracy, timeliness, and compliance with contractual and regulatory requirements
Monitor and review claims payment processes, identifying opportunities for process improvement and risk mitigation
Direct the reconciliation of claims payments, maintaining detailed records and ensuring resolution of discrepancies
Manage accounts receivable and recoupment processes, coordinating with finance and provider relations teams to ensure timely recovery and reporting
Lead banking coordination and reporting activities, working closely with finance to maintain transparency and accuracy in financial transactions related to claims
Qualification
Required
U.S. Citizenship is required for this role due to Department of Defense contract
Must successfully receive interim approval for government security clearance (NBIS- National Background Investigation Services)
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
Bachelor's degree in Accounting, Finance, Business, Health Care Administration, Government Contract Management, or Operations Management or if non-degree, must have at least 5 years of experience with TRICARE and/or VA CCN in claims or financial transaction area
5 years of experience in a managed care environment and financial transactions and claims area
Experience with VA, TRICARE contracts and/or the military health care delivery system, and/or Medicare reimbursement
Experience with data analysis and making decisions using data
Benefits
Medical
Dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Many other opportunities
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Nwando Olayiwola
Chief Health Equity Officer & Senior Vice President
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase