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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims operations and provider data management, with a strong focus on process improvement, performance analysis, and operational efficiency. Proficient in developing metrics and reporting to guide decision-making and enhance compliance with VA and TRICARE requirements.
Highest-signal resume keywords
Claims Operations ExperienceProcess Improvement ExpertiseData Analysis and ReportingSQL/PLSQL ProficiencyStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims OperationsProcess ImprovementData AnalysisPerformance Metrics DevelopmentWorkflow DesignSQLPLSQLReporting ToolsDashboard ToolsBusiness Process Optimization
Soft Skills
Detail OrientedSelf-MotivatedStrong Organizational SkillsCritical ThinkingAbility to Prioritize Workload
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointBusiness SystemsReporting Tools
Certifications & Qualifications
U.S. CitizenshipGovernment Security Clearance
Industry Keywords
VA CCN RequirementsTRICARE ProgramsHealthcare OperationsOperational Issue ResolutionUser Acceptance Testing
Tech Stack
Tools & technologiesSQL
About the role
Key responsibilities & impact- Analyze provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities
- Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies
- Recommend and help implement process improvements that increase efficiency, accuracy, quality, and consistency
- Develop metrics, reporting, and root cause analyses to measure performance and guide improvement efforts
- Partner with operations, process, and product teams on issue resolution, testing, automation opportunities, and process enhancements
- Support user acceptance testing, training, and communication for process and system changes
- Maintain knowledge of VA CCN requirements, provider systems, and claims operations
- Support compliant and effective process oversight
- Perform other duties and tasks requested by the supervisor consistent with company objectives
- Work cross-functionally with operations, business, and technology partners on process modernization and continuous improvement initiatives aligned with TRICARE and government requirements
- Occasional travel to Humana offices for training or meetings may be required
Requirements
What you’ll need- 5 or more years of experience in claims operations, provider data, process improvement, or healthcare operations
- Experience developing metrics, reporting, and performance analysis to support operational improvement
- Experience analyzing business processes, identifying root causes, and recommending or implementing process improvements
- Self-motivated, detail oriented, and able to prioritize workload
- Strong written and verbal communication skills
- Ability to present findings and recommendations to business partners and leadership
- Strong organizational skills and ability to manage multiple priorities, meet deadlines, and work independently
- Proficiency with business systems, reporting tools, and Microsoft Office applications, especially Excel and PowerPoint
- Proficiency with reporting/dashboard tools used by the department
- Detail orientation and critical thinking skills
- Ability to interpret data, identify trends, and resolve moderately complex operational issues
- 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
- Strong knowledge of or working experience with big and complex data sets, including running queries and interpreting data with SQL/PLSQL
- Knowledge of or experience working for VA or TRICARE programs preferred
- Prior experience with workflow design and business process optimization preferred
- Ability to learn a complex processing system
Benefits
Comp & perks- Bonus incentive plan based upon company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Remote work
- Dedicated home workspace requirement to protect PHI/HIPAA information
- Internet service requirements for home employees