Process Manager, CRU and Correspondence – Louisville

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Assignment Summary:
The Process Manager in the Customer Care Process and Quality Organization will work to standardize and enhance existing processes within the Claims Research Unit (CRU) and Correspondence (Corr) departments while searching for opportunities to implement new processes/technologies as well. Additional responsibilities include...

• Analyze and evaluate existing issue resolution applications and collaborates with service centers Subject Matter Experts (SME's).
  
• Develops and maintains internal and external relationships that serve as a resource of technical knowledge and performance improvement.
  
• Serves as SME for CRU/Corr processes.
  
• Resolves routine and complex customer inquiries through consistent use of work practices and best know methods.
  
• Demonstrates expert knowledge of current benefit plans, policies and procedures.
  
• Displays initiative and thorough research in problem identification and resolution.
  
• Uses relationships developed with internal and external stakeholders to achieve inquiry resolutions effectively and efficiently.
  
• Identifies and communicates opportunities for process improvement.
  
  Minimum Requirements:
  
• Degree strongly desired
  
• Minimum 2 years experience with CRU and/or Correspondence
  
• (A plus) green or black belt process certification or knowledge
  
  Knowledge, Skills, and Abilities:
  
• Knowledge of state/federal requirements related to written submissions
  
• Knowledge of internal routing systems including ACS procedures, the Eligibility module, Macess and CCP
  
• Knowledge of class action settlement impacts on processes, including working with external vendors
  
• Critical Thinking Skills
  
• Decision Making Ability
  
• Ability to think globally
  
• Understanding of Process mgmt, PMCS
  
• Ability to collaborate, gain consensus
  
• Will need to be able to work across many areas of the company, (CRU, Correspondence, Strategic Consultancy, Claims Process Org, IT, etc)
  
• Basic knowledgeable on Fully Insured, Self-Funded, and National Accounts
  
• Detailed knowledge of CRU and Corr
  
• Product knowledge on design and how the business flows in and out
  
• Expert of CCP and knowledgeable regarding IVR
  
• Solid basis on Humana's view of the system. Have global knowledge of what departments do what. This will ensure this person knows their authority of suggesting process improvements and making sure, they have considered all impacted departments
  
• Ability to resolve routine and complex customer inquiries through consistent use of work practices and best-known methods
  
• Expert knowledge of current benefit plans, policies and procedures.
  
• Ability to represent Humana as the spokesperson for the Customer Care and Call Quality team and Strategic Consultancy
  
• Basic understanding of project management disciplines. Experienced project methodology (not to have project led but understand the critical path of project work)
  
• Basic facilitation practices: Prepare agendas, schedule meetings, facilitates meetings, and takes complete and accurate meeting minutes
  
• Basic communication style - knows appropriate detail level with audiences, clear and concise
  
• Ability to conduct process checks
  
• Experience developing process improvement
  
• Decision-making skills (be sure the decision is yours to make, define the problem carefully, anticipate problems, give attention to the important decisions (keep in perspective), make necessary minor decisions promptly, don't make snap decision on critical matters, overcome your fear of failure. Learn from past mistakes.
  
• Ability to hold people accountable and responsible
  
• Ability to work in a virtual environment (e.g. sametime opportunities, video conferencing, etc.)
  
• Must be self-directed and motivated
  
• Ability to multi-task
  
• Good organizational skills
  
• Recognize conflict and escalates appropriately
  
• Ability to provide input to project/initiative risks
  
• Ability to forecast schedule and
  
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