Senior Process Improvement Professional
Core
Analyze provider data and claims processes to identify gaps, risks, and trends; develop metrics and reporting to improve quality, reduce risk, and support timely claim processing.
Role type
Senior Process Improvement Professional (Claims Operations)
Builds
Process improvements for provider data quality and claims resolution
Domain
Healthcare / Insurance Claims Operations
Deliverable
dashboards & analysis
Required skills
Claims operations analysis, Provider data management, Process improvement, Metrics development, Root cause analysis, Reporting tools, Microsoft Office (Excel, PowerPoint), Critical thinking, Data interpretation, Workflow management
Preferred skills
SQL/PLSQL, VA or TRICARE program experience, Workflow design, Business Process Optimization
Responsibilities
Analyze provider data and claims processes to identify gaps and improvement opportunities; Support daily claim deferral and workflow management; Recommend and implement process improvements; Develop metrics and root cause analyses; Partner with operations and product teams on issue resolution and automation; Support UAT and training for process changes.
Seniority
Senior, hands-on IC
