Remote TRICARE Claims & Policy Specialist

Humana; Carson City (NV); Remote; USD 54,000 - 73,000; Full time

Job summary

Humana, Inc. seeks a Claims Process and Policy Professional to handle TRICARE claims processing, research and customer inquiries. This remote role emphasizes accuracy, policy knowledge, and teamwork with a strong customer-service focus.

The position requires U.S. citizenship, NBIS clearance, and up-to-date knowledge of TRICARE rules. Travel to Humana offices may be required occasionally; substantial remote work is supported.

Qualifications

• 3+ years of TRICARE contract work with claims processing, provider research or administering the benefit.
• 3+ years of experience analyzing data for reports.
• Experience providing clear written responses to customer inquiries.
• Excellent communication and presentation skills to senior/executive level leadership.
• U.S. citizenship required for Department of Defense contract.
• Successfully receive approval for government security clearance (NBIS).
• HGB is not authorized to do work in Puerto Rico per our government contract.

Responsibilities

• Identify root causes using the intake process and perform claims research.
• Increase knowledge to become a claims SME.
• Meet established expectations and achieve results.
• Assist peers with root cause analysis and more complex issues.
• Attend required trainings to develop skills around complex topics.
• Stay informed on TRICARE program and reimbursement methodologies impact on daily work.
• Model integrity, meet commitment dates and take responsibility for actions.

Skills

TRICARE claims processing

Data analysis for reports

Customer inquiries responses

Communication & presentations

NBIS security clearance

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. seeks a Claims Process and Policy Professional to handle TRICARE claims processing, research and customer inquiries. This remote role emphasizes accuracy, policy knowledge, and teamwork with a strong customer-service focus.

The position requires U.S. citizenship, NBIS clearance, and up-to-date knowledge of TRICARE rules. Travel to Humana offices may be required occasionally; substantial remote work is supported.