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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in business process analysis and improvement, particularly in claims processing within the healthcare sector. Proficient in utilizing data analysis and project coordination to drive effective change management and optimize operational efficiency.
Highest-signal resume keywords
Business Process ImprovementClaims AdjudicationSQL/PLSQL Data AnalysisHealthcare Applications KnowledgeProject Coordination
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Business AnalysisData InterpretationProcess ManagementQuantitative MeasurementWorkflow DesignBusiness Process OptimizationChange ManagementRoot Cause AnalysisMicrosoft Office SuiteExcel Proficiency
Soft Skills
Excellent CommunicationPresentation SkillsResults-Driven MindsetProblem-SolvingPrioritization
Certifications & Qualifications
Government Security Clearance
Industry Keywords
TRICAREMedicareHealthcare TechnologyClaims ProcessingData SetsBenchmarkingBest Practices
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Analyze and measure the effectiveness of existing business processes
- Develop sustainable, repeatable and quantifiable business process improvements
- Oversee timely and accurate processing of TRICARE claims with the East Contract claims processing subcontractor
- Analyze and identify claims processes requiring improvement due to business initiatives, system issues or government-directed changes
- Analyze TRICARE policy and industry guidelines to create, improve and implement processes and practices affecting claims processing
- Gather data, draw insights, make recommendations and influence strategy
- Evaluate change through quantitative and qualitative measurement against goals and benchmarks
- Provide project and program coordination for implementing new or modified processes
- Assist with change management to minimize disruption and maximize impact
- Research best practices and establish benchmark data
- Collect and analyze process data to recommend practices focused on safety, productivity and cost reduction
- Determine how new information technologies can support business process re-engineering
- Understand business problems and opportunities and recommend solutions supporting Humana's brand and value proposition
Requirements
What you’ll need- 5 or more years of business analysis, testing or process management experience
- Current experience with understanding claims adjudication, systems and reporting
- Strong knowledge of and/or working experience with big and complex data sets
- Experience running queries and interpreting data with SQL/PLSQL
- Knowledge in healthcare-related applications and technology
- Ability to manage and prioritize multiple initiatives with minimal guidance
- Excellent communication and presentation skills, including presenting technical details to senior and executive leadership
- Results-driven mindset with ability to achieve established individual and organizational goals
- Experience researching and analyzing data to determine root cause
- Experience reading and interpreting contracts, policy and operations manuals
- High-level problem-solving and analytical experience
- Proficiency in Microsoft Office Suite, Excel, PowerPoint and Word
- U.S. citizenship required
- Must successfully receive approval for government security clearance via National Background Investigation Services (NBIS)
- Must not currently live in Puerto Rico
- Bachelor's Degree preferred
- Knowledge of Medicare and/or TRICARE preferred
- Previous experience managing or leading programs, technical implementations and/or initiatives preferred
- Prior experience with workflow design and business process optimization preferred
- Ability to learn a complex processing system preferred
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Home-based remote work
- Occasional travel to Humana offices for training or meetings
- Dedicated home workspace support for protecting PHI/HIPAA information
- Internet service requirements/support for remote work