Become a part of our caring community and help us put health firstHumana is seeking a Process Improvement Professional to support the Wisconsin Medicaid market. The Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
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 i Care staff to learn about new i Care 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, i Care brochures, i Care 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 i Care 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.
Use your skills to make an impactRequired Qualifications
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 Qualifications
3 years of documentation, audit and analysis experience in a managed care or health insurance environment.
A degree in business or related field.
Additional Information
Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
Typical Work Days/Hours: must be available to work Monday - Friday, 8:30 am - 5:00 pm Central Standard Time (CST).
WAH Internet RequirementsTo 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 recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
BenefitsHumana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
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
HireVueAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.Scheduled Weekly Hours40Pay RangeThe 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.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.