Director Process Improvement

Overview

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

• 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.

• U.S. Citizenship is required for this 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 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, at least 5 years of experience with TRICARE and/or VA CCN in claims or financial transaction areas.
• 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.

• To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service must meet the following criteria: minimum download speed 25 Mbps and minimum upload speed 10 Mbps; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connections can be used only if approved by leadership.
• Associates who live and work from Home in the states of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours
40

Pay Range
$150,000 - $206,300 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Benefits include medical, dental and vision coverage, 401(k) retirement savings plan, paid time off (including PTO, company and personal holidays, volunteer time off, paid parental and caregiver leave), disability coverage, life…