Process Improvement Specialist

UNITE HERE HEALTH

serves over 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The purpose of the Process Improvement Specialist is to lead and drive process improvement initiatives across Operations, with primary focus on Claims and Contributions & Enrollment, while working in an integrated manner with Member Services and Claims Cost Management to support as needed. This role identifies process gaps, performs root cause analysis, standardizes workflows, and implements sustainable solutions to improve efficiency, reduce errors, and enhance the member experience.

Primary responsibilities include developing and optimizing procedures, establishing performance metrics, driving cross-functional improvements, and ensuring processes are consistent, effective, and aligned with Fund goals.

ESSENTIAL JOB FUNCTIONS AND DUTIES

Acts as the primary point of contact for process improvement initiatives across Operations, with primary focus on Claims and Contributions & Enrollment, and is integrated with Member Services and Claims Cost Management to provide support as needed.

Leads end-to-end process improvement and cross-functional projects from identification and requirements gathering through testing, implementation, and post-production supportIdentifies process gaps, inefficiencies, and recurring issues through root cause analysis (including complaints and audit findings) and implements corrective actions to prevent recurrenceEvaluates current-state processes, maps future-state workflows, and develops standardized procedures, job aids, and operational guides to improve consistency, accuracy, and turnaround timesPartners with Operations leadership, business stakeholders, and system teams to define priorities, scope, timelines, dependencies, and deliverables for process and system improvement initiativesCoordinates project resources, facilitates meetings, tracks action items, and monitors milestones to ensure initiatives stay on schedule and aligned with business and regulatory requirementsEstablishes, tracks, and reports on key performance metrics (KPIs) to measure process effectiveness, outcomes, and continuous improvement Leads change management efforts, including communication, training, and adoption of new processes and workflows across departments Monitors implemented solutions to ensure sustained results, identifies additional improvement opportunities, and drives continuous improvementIdentifies system and workflow gaps and partners with IT and system teams to implement enhancements, automation, and data integrity improvements Coordinates and supports testing activities (regression and validation) for system changes, ensuring accuracy and successful deploymentSupports audit readiness by gathering documentation, validating controls, and incorporating audit findings into process improvements to reduce risk and ensure compliance Maintains project tracking tools and provides clear, concise status reporting to Operations leadership, including progress, risks, issues, and outcomes Builds and maintains strong relationships with stakeholders to drive collaboration, accountability, and successful delivery of initiativesSupports and collaborates with other Operations Administrative roles to ensure alignment, coverage, and execution of departmental priorities and initiativesAssists with operational reporting, data review, and ad hoc analysis to support leadership decision-making and performance monitoring Drives process improvements by setting clear goals and delivering measurable results tied to operational performance and departmental objectivesContributes ideas and recommendations for workflow redesign, system optimization, and best practices to support departmental and Fund goalsExemplifies the Funds BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusionPerforms other duties as assigned within the scope of responsibilities and requirements of the jobPerforms Essential Job Functions and Duties with or without reasonable accommodation

ESSENTIAL QUALIFICATIONS

Years of Experience and KnowledgeMinimum 35 years of relevant experience in healthcare operations, including claims, enrollment, eligibility, or related administrative functionsExperience managing or supporting projects involving process improvement, workflow redesign, system enhancements, or operational changeStrong understanding of healthcare business processes and how claims, enrollment, eligibility, and member services work togetherProven ability to gather business requirements, document workflows, coordinate testing, and support implementation of operational and system changesWorking knowledge of project management tools (e.g., MS Project) preferredStrong analytical, organizational, and problem-solving skillsEducation, Licenses, and CertificationsBachelors degree in Healthcare Administration, Business Administration, or related field, or equivalent work experience required

Preferred:

Six Sigma Green Belt, Project Management Professional, or other process improvement / project management certificationSkills and AbilitiesStrong communication skills with the ability to provide clear, concise updates to leadershipAbility to manage multiple projects and priorities in a fast-paced environmentStrong attention to detail with a focus on accuracy and qualityAbility to analyze data, identify trends, and make actionable recommendationsEffective collaboration skills with the ability to work across departments and build strong relationshipsAbility to lead change, influence stakeholders, and drive adoption of new processesExtensive experience in data analysis and reporting, with strong working knowledge of Microsoft Office (Excel, Word, PowerPoint)20% travel as needed

OTHER JOB FUNCTIONS AND DUTIES

The information contained in this job description is designed to indicate the general nature and level of work performed in this job with a certain degree of specificity, where warranted. In no instance, however, should the duties, functions, qualifications, or requirements be interpreted as all-inclusive. Management may, at its discretion, assign or reassign functions and duties to or from this job at any time, due to reasonable accommodation or other reasons. Listed requirements, skills, qualifications and abilities included have been determined to illustrate the minimal standards required to successfully perform the position.

Salary range for this position: Salary $64,100 - $80,100. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).#LI-HYBRID