Director Process Improvement

Overview

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The Director, Process Improvement provides direction and management to the claims processing vendor for claims reimbursements and operational activities to provide superior service to internal and external customers in support of the VA Community Care Network. The Director, Process Improvement coordinates with the Director, VA CCN Claims Oversight for alignment of accurate claims processing. Ensures a high level of quality in all areas while meeting or exceeding performance goals.

This position is created specifically to assist with Humana’s efforts to secure and, if awarded, transition into a new business opportunity. Please note that continued employment in this role is expressly contingent upon Humana’s receipt of the business opportunity and a satisfactory transition into the work. In the event Humana does not pursue the opportunity or determines that a timely and satisfactory transition cannot be achieved, employment may be subject to termination.

The Director of Claims Oversight will lead a dedicated team responsible to establish and maintain comprehensive oversight of the VA CCN payment invoicing process with a focus on vendor management and payment integrity. This role ensures timely reconciliation of VA payments, effective management of accounts receivable and recoupments, administration and oversight of X12 processes and files as well as coordination of banking and reporting activities.

The Director will serve as a key liaison between internal stakeholders and claims vendors to optimize operational efficiency and compliance with regulatory standards.