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Authorization and Referral Claims Process Improvement Lead

Humana -
Remote

Apply Now

Job Details

Full-time
$94,900 - $130,500 a year
3 days ago

Benefits

Paid parental leave
Caregiver leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Parental leave
Vision insurance
Life insurance

Qualifications

Optimizing workflow processes
Medical claims processing
Project change management
Presentations for conferences or internal meetings
Change management
Quality improvement
Project delivery management
Data interpretation
Managing projects
Productivity software
Process improvement planning
Cross-functional collaboration
Project leadership
Cross-functional team management
Cross-functional communication

Full Job Description

Become a part of our caring community

The 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 cause
Facilitate workshops, working sessions, and improvement events
Communicate progress, risks, and outcomes to leadership
Analyze operational data to identify trends and improvement opportunities
Build reports/dashboards to monitor improvements and define KPIs and metrics to measure process performance
Ensure processes are scalable, repeatable, and compliant
Evaluate current business processes to identify inefficiencies, bottlenecks, and risks
Analyze customer needs, stakeholder expectations, and relevant data to understand value drivers and determine claims impacts
Collaborate 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 purposed
Translate business needs in technical impacts for claims process
Ensure Compliance and Policy alignment with new opportunities and changes

Use your skills to make an impact

Required Qualifications

Minimum 2 years of experience processing and/or researching claims using CAS
Minimum 2 years of experience leading and implementing process improvement initiatives
Demonstrated experience the use of Microsoft Office applications including Word, Excel, Access, PowerPoint, and Visio
Demonstrated ability to analyze data and draw actionable conclusions and make decisions
Experience facilitating and communicating among claims and cross functional teams.
Experience presenting complex concepts to peers, stakeholders, leadership, and partners
Experience managing multiple, diverse projects
Strong motivation to expand process improvement knowledge and expertise
Experience applying analytical and problem-solving skills
Experience with project and change management

Preferred Qualifications

Bachelor's degree
Previous experience with Medicaid/Medicare authorization and referral processes

Additional Information

Hours 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 Hours

Pay Range

The 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 year

This 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: 07-16-2026

About us

About 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 Employer

It 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.

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