Senior Process Improvement Professional (Healthcare)

Location: Remote nationwide within the United States; candidates currently living in Puerto Rico cannot be hired. Occasional travel to hirify.global offices for training or meetings may be required.

Salary: $78,400–$107,800 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, military, individual, and family populations.

What you will do

• Analyze TRICARE policy, industry guidelines, and claims processes to create and implement sustainable improvements.
• Partner with the East Contract claims processing subcontractor to oversee timely and accurate claims processing.
• Gather, query, and interpret complex data to identify root causes, develop recommendations, and influence strategy.
• Measure process changes against goals and benchmarks using quantitative and qualitative analysis.
• Coordinate projects, programs, technical implementations, and process modifications while supporting change management.
• Evaluate how information technology can enable business process re-engineering and improved service delivery.

Requirements

• At least 5 years of experience in business analysis, testing, or process management.
• Current experience with claims adjudication, claims systems, and reporting.
• Strong experience working with complex data sets and using SQL/PLSQL query languages.
• Knowledge of healthcare applications and technology, with the ability to interpret contracts, policies, and operations manuals.
• Strong analytical, problem-solving, communication, and presentation skills, including communication with senior and executive leadership.
• U.S. citizenship and successful approval for a government security clearance through NBIS are required; candidates living in Puerto Rico cannot be hired.

Nice to have

• Bachelor's degree.
• Knowledge of Medicare and/or TRICARE.
• Experience leading programs, technical implementations, or initiatives.
• Experience with workflow design and business process optimization.
• Ability to learn complex processing systems.

Culture & Benefits

• Remote work with a dedicated, interruption-free workspace required to protect member PHI and HIPAA information.
• Home internet service must provide at least 25 Mbps download and 10 Mbps upload speeds.
• Benefits include medical, dental, and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.
• Full-time schedule of 40 hours per week.