Remote TRICARE Claims & Policy Specialist

Humana, Inc.; Austin (TX); Remote; USD 54,000 - 73,000; Full time

Job summary

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims processing inquiries and policy questions. The role emphasizes accuracy and research, working with beneficiaries, providers, and partners to resolve issues within established rules.

The position supports remote work with periodic training and potential travel for meetings. A DoD contract requires U.S. citizenship and NBIS clearance.

Qualifications

• 3+ years of experience with TRICARE contract working with claims processing, provider research or administering the benefit.
• 3+ years of experience analyzing data for reports.
• Experience providing clear and concise written responses to customer inquiries.
• Excellent communication and presentation skills including the ability to communicate technical details to senior and executive leadership.
• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive approval for government security clearance (NBIS).
• HGB is not authorized to do work in Puerto Rico per our government contract; not hiring candidates in Puerto Rico.

Responsibilities

• Identify root causes through the intake process.
• Research claims to determine impact to reported issues.
• Identify improvement opportunities based on analysis performed.
• Increase knowledge to become a claims SME.
• Meet established expectations and achieve results.
• Assist peer group on root cause identification and more complex issues.
• Attend required training to develop new skills in more complex topics.

Skills

Excellent communication and presenting

Data analysis for reports

Clear written responses to inquiries

Present to senior/executive leadership

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims processing inquiries and policy questions. The role emphasizes accuracy and research, working with beneficiaries, providers, and partners to resolve issues within established rules.

The position supports remote work with periodic training and potential travel for meetings. A DoD contract requires U.S. citizenship and NBIS clearance.