Description and Requirements We are seeking a dedicated and detail-oriented Claims Modernization Process Engineer to serve as a leader and implementer on our approach to a unified and streamlined claims and provider payment process. The primary goal of this role is to deliver best-in-class service to our members and providers by aligning business processes with technology to ensure efficient operations and compliance with federal, state, and commercial programs. The Claims Modernization process engineer will focus on execution, outcomes, continual improvement, and performance enhancement. This role is instrumental in ensuring overall adherence to regulatory expectations while driving improvements in the quality of work output. It requires collaboration across teams and departments to ensure enterprise-wide strategies are successfully executed and achieved. Additionally, the ideal candidate will leverage their expertise in Value Stream Mapping (VSM), SIPOC creation, and Lean management to visualize workflows, identify inefficiencies, and implement actionable improvements. They will support strategic initiatives and align processes with organizational goals, ensuring measurable impacts across operational workflows.

Duties & Responsibilities:

Unified Process Improvement: Support the modernization of claims and provider payment processes to achieve alignment between operations and technology.Process Mapping and Value Stream Mapping (VSM): Develop detailed process maps and value stream analyses to identify inefficiencies and opportunities for improvement.Lean Management: Apply Lean principles to streamline operations, reduce waste, and enhance overall process effectiveness.SIPOC Creation: Define and document Suppliers, Inputs, Processes, Outputs, Customers to establish process clarity.Establish KPI’s and measures of success: Collaborate with leadership and implement KPI’s that aligned with strategic objectives and drive data-informed decisions. Data-Driven Decision Making: analyze data to evaluate processes and support evidence-based improvements.Stakeholder Collaboration: Build and maintain strong relationships across the organization to align stakeholders and ensure end-user adoption of new solutions.Reporting and Communication: Provide clear documentation and presentations to stakeholders, summarizing findings, progress, and results.Additional duties as assigned.

Minimum Qualifications

Strong knowledge of Lean management, process mapping, and value stream mapping methodologies.Excellent problem-solving and analytical skills, with a data-driven approach to decision-making.Exceptional communication and presentation skills, with the ability to influence stakeholders at all levels.Project management experience, including the ability to manage multiple activities simultaneously.High School Degree

Preferred Qualifications:

Bachelor’s or master’s degree from an accredited institution in a relevant field (e.g., Operations Management, Business Administration) or equivalent work experience.Certification in Lean Six Sigma (Green Belt or Black Belt) or compatible certification.5+ years of experience in operational excellence, process improvement, or a related field.Industry experience in healthcare, health insurance, or a related sector.Proven track record of supporting or leading recognized Operational Excellence programs

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470

All Other Locations (within approved locations): $71,600 - $106,505

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.