Authorization and Referral Claims Process Improvement Lead

Become a part of our caring communityThe Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.The Process Improvement Lead will work closely with the Authorization and Referral Process team on large scale initiatives and new concepts to help translate business need into technical

Requirements

.

Key Responsibilities

include:Partner with business leaders, teams, and cross-functional groups to Lead process analysis and root causeFacilitate workshops, working sessions, and improvement eventsCommunicate progress, risks, and outcomes to leadershipAnalyze operational data to identify trends and improvement opportunitiesBuild reports/dashboards to monitor improvements and define KPIs and metrics to measure process performanceEnsure processes are scalable, repeatable, and compliantEvaluate current business processes to identify inefficiencies, bottlenecks, and risksAnalyze customer needs, stakeholder expectations, and relevant data to understand value drivers and determine claims impactsCollaborate with cross-functional partners to validate assumptions and support decision-making.Partner with stakeholders (Clinical, Process, IT, and operations) to align on vision, scope, and delivery of initiatives or new

Requirements

.Collaborate with Process Leadership to ensure alignment on need and priority of initiatives that are being purposedTranslate business needs in technical impacts for claims processEnsure Compliance and Policy alignment with new opportunities and changesUse your skills to make an impact Required

Qualifications

Minimum 2 years of experience processing and/or researching claims using CASMinimum 2 years of experience leading and implementing process improvement initiatives Demonstrated experience the use of Microsoft Office applications including Word, Excel, Access, PowerPoint, and VisioDemonstrated ability to analyze data and draw actionable conclusions and make decisionsExperience facilitating and communicating among claims and cross functional teams.Experience presenting complex concepts to peers, stakeholders, leadership, and partnersExperience managing multiple, diverse projectsStrong motivation to expand process improvement knowledge and expertiseExperience applying analytical and problem-solving skillsExperience with project and change managementPreferred

Qualifications

Bachelor's degreePrevious experience with Medicaid/Medicare authorization and referral processesAdditional InformationHours for this position are based on EST or CST.Work at Home

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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.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 Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.

The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$94,900 - $130,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of

Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive

Benefits

that support whole-person well-being. Associate

Benefits

are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our

Benefits

, Humana provides medical, dental and vision

Benefits

, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 07-16-2026About usAbout Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.

These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.​Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job

Requirements

. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.Originally posted on Himalayas