Become a part of our caring community and help us put health first
 

Humana 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 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.

           

Use your skills to make an impact
 

Required 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 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 recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connecti