VP, Claims Process & Operations

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

Humana is a $100+ billion (Fortune 38) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong wellbeing. As a company focused on the health and wellbeing of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a wholeperson view of human wellbeing, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking an accomplished executive to join our team and lead our claims horizontal. The VP, Claims Process & Operations will play an essential strategic and operational role in delivering Humana’s value proposition to our customers. To support Humana’s customer growth, retention, and satisfaction, the Claims Operations team ensures Humana’s 9+ million Medicare and Medicaid members receive the access to care they need and claim payments associated with their care are paid accurately and timely. The work the team does is critical to our compliance with industry regulations and to numerous downstream processes.

Operational savviness is key to the success of this role. The 1,200+ Claims Operations associates, coupled with the support of our external partners, are customerfocused and ensure the highest operational standards for more than 240M claims processing transactions associated with our 9+ million members.

Reporting to the Senior Vice President of Claims Administration and Payment Integrity (CAPI), this leader will manage a $132M+ operating budget with 4 direct reports.

Applicants living in Central or Eastern time zone are preferred.

Key Responsibilities

• Responsible for leading the daytoday execution of a largescale operations team in addition to leading modernization of enterprise claims operations
• Lead the design and implementation of new claims processes to support our growing business and modernizing our enterprise claims operating platforms
• Act as the horizontal leader for claims
• Strategy development and execution – partner with internal and external stakeholders to develop and deliver solutions that improve customer experiences and business results
• Results orientation – drive for outcomes that are balanced across multiple dimensions (customer experience, compliance, financial, associate experience, etc.)
• Process mindset – ability to navigate business operations with complex processes and systems

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  Use your skills to make an impact
  

  Key Candidate Qualifications

  The successful candidate will bring deep expertise in claims operations, strong leadership capabilities, and a track record of transforming complex processes through technology, analytics, and innovation. Possessing a deep experience in endtoend claims lifecycle, overseeing the strategic direction, operational efficiency, and performance of the claims functions will allow this leader to ensure timely, accurate, and customerfocused claims processing, while driving continuous improvement, regulatory compliance, and coseffective operations.

  In addition to the above, the following professional qualifications and personal attributes are also sought:

  • Bachelor’s degree, preferably in a businessrelated field.
  • 8+ or more years of management experience (leading a large team within operations environment at a large corporation).
  • 5 or more years of healthcaremanaged care industry experience.
  • Proven ability to excel in a dynamic, changing, and fastpaced environment.
  • Prior leadership experience driving process improvement, leveraging data and analytics, and ensuring regulatory compliance.
  • Proven ability to build highperforming teams by identifying, cultivating, and motivating top talent from inside and outside of the organization
  • Strong computer skills (e.g. Excel, Word, PowerPoint and other programs required for assimilating and presenting reports).
  • Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences
  • Sound business and financial acumen with ability to apply knowledge to business challenges.
  • Welldeveloped and broad knowledge of the healthcare ecosystem
  • A record of success in facilitating and managing multiple highprofile, highimpact strategy projects endtoend, including allocation and management of resources, setting milestonestiming and scorecards, and holding others accountable
  • Ability to work through tumultuous or ambiguous scenarios successfully.
  • Current or recent experience in a large, highly matrixed company (i.e., Fortune 150), with proven ability to influence leaders and key stakeholders in such an environment
  • Highly collaborative mindset and excellent relationshipbuilding skills, including the ability to engage many diverse stakeholders and SMEs and win their coownership in the outcome

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

    Scheduled Weekly Hours

    40

    
    About us
    

    Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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    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.