Process Improvement Specialist

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 support
• Identifies process gaps, inefficiencies, and recurring issues through root cause analysis (including complaints and audit findings) and implements corrective actions to prevent recurrence
• Evaluates current-state processes, maps future-state workflows, and develops standardized procedures, job aids, and operational guides to improve consistency, accuracy, and turnaround times
• Partners with Operations leadership, business stakeholders, and system teams to define priorities, scope, timelines, dependencies, and deliverables for process and system improvement initiatives
• Coordinates project resources, facilitates meetings, tracks action items, and monitors milestones to ensure initiatives stay on schedule and aligned with business and regulatory requirements
• Establishes, 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 improvement
• Identifies 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 deployment
• Supports 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 initiatives
• Supports and collaborates with other Operations Administrative roles to ensure alignment, coverage, and execution of departmental priorities and initiatives
• Assists 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 objectives
• Contributes ideas and recommendations for workflow redesign, system optimization, and best practices to support departmental and Fund goals
• Exemplifies the Fund's BETTER Values and Professional Effectiveness Dimensions in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
• Performs other duties as assigned within the scope of responsibilities and requirements of the job
• Performs Essential Job Functions and Duties with or without reasonable accommodation

Essential Qualifications

Years Of Experience And Knowledge

• Minimum 35 years of relevant experience in healthcare operations, including claims, enrollment, eligibility, or related administrative functions
• Experience managing or supporting projects involving process improvement, workflow redesign, system enhancements, or operational change
• Strong understanding of healthcare business processes and how claims, enrollment, eligibility, and member services work together
• Proven ability to gather business requirements, document workflows, coordinate testing, and support implementation of operational and system changes
• Working knowledge of project management tools (e.g., MS Project) preferred
• Strong analytical, organizational, and problem-solving skills

Education, Licenses, And Certifications

• Bachelor's 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 certification

Skills And Abilities

• Strong communication skills with the ability to provide clear, concise updates to leadership
• Ability to manage multiple projects and priorities in a fast-paced environment
• Strong attention to detail with a focus on accuracy and quality
• Ability to analyze data, identify trends, and make actionable recommendations
• Effective collaboration skills with the ability to work across departments and build strong relationships
• Ability to lead change, influence stakeholders, and drive adoption of new processes
• Extensive 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).