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Company

Humana · 2 hours ago

Process Improvement Professional

Remote Wisconsin

Full-time

Remote

Mid Level

$63K/yr - $87K/yr

3+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

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Responsibilities

Assist with and support Operations management in establishing procedures incorporating company policy and efficiencies in all workflow processes.

Develop and maintain user-friendly formalized Intradepartmental Desk Procedures (IDPs) for all Operations-related functions obtain Operations management approval and take steps to have the procedures published on the company IDP Intranet site.

Communicate departmental changes to policies and procedures, system functionality and payment methodologies to the Operations staff.

Work with non-Operations iCare staff to learn about new iCare products, processes and workflows to support company collaboration.

Assist Operations staff with daily claims, enrollment and provider services issues in a manner to help them develop and use their own research and analytical skills. Develop job aids to assist with the efficient performance of the various job functions.

Research benefits issues, as required, using all available resources. (i.e. DHS and CMS websites, contracts, iCare brochures, iCare policies and procedures, etc.)

Identify and research new processing issues, communicate the findings and as required update the IDPs.

Assist with the establishment of audit procedures and perform audits to analyze the performance of Operations staff. Keep detailed records of the results, furnish feedback to Operations management and make recommendations regarding the improvement of Operations procedures.

Perform periodic audits of the claims processing vendor’s performance, keep detailed records of the results and furnish an analysis of the issues identified and possible solutions related to the system configuration or Operations procedures.

Assist with government audits to support Centers for Medicare and Medicaid Service (CMS) and Department of Health Services (DHS) to comply with regulatory and contractual requirements.

Coordinate the configuration process which may include:

Assisting with the creation of configuration documents,

Communication of the configuration information to the vendor

Verification of configuration accuracy in the system

Participate in the establishment and use of a product-related government contact that is available and knowledgeable in the processing detail needed by an Operations area to administer the iCare product contracts.

Participate in successful completion of Operations related projects, department initiatives, and company developed strategies. Participation includes business requirement gathering, testing activities, pre-implementation training, and post production support and validation.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Process ImprovementHealth Insurance ExperienceData AnalysisBusiness DocumentationAudit ProceduresResearch ToolsMedicaid ExperienceMedicare ExperienceLong-Term Care ExperienceBusiness DegreeCollaboration Skills

Required

Minimum of three (3) years’ experience supporting health insurance or managed care business in an operational setting. Medicaid, Medicare, or Long-Term Care experience is a plus.

Experience in working to define problems, collect data, establish facts, and draw valid conclusions.

Experience preparing business documents, reporting analysis findings and offering suggestions for performance improvement.

Experience utilizing research tools and information to obtain business measures.

Preferred

3 years of documentation, audit and analysis experience in a managed care or health insurance environment.

A degree in business or related field.

Benefits

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

Recognition pay

401(k) retirement savings plan with employer match

Tuition assistance

Scholarships for eligible dependents

Parental and caregiver leave

Employee charity matching program

Network Resource Groups (NRGs)

Career development opportunities

Medical, dental and vision benefits

Short-term and long-term disability

Life insurance

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10,001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)