Remote TRICARE Claims & Policy Specialist

Humana; Jackson (MS); 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 and policy inquiries, research rule accuracy, and collaborate with teammates to provide correct answers for customers.

The role emphasizes root cause analysis, ongoing training, and opportunities to become a claims SME. The position is remote with potential travel for training, with a 40-hour workweek and a starting pay range reflective of the market.

Qualifications

• 3+ years of TRICARE claims processing or provider research.
• 3+ years of data analysis for reports.
• Experience writing clear responses to customer inquiries.
• Excellent communication and presentation skills for leadership.
• U.S. citizenship required for DoD contract.
• Ability to obtain NBIS security clearance.
• Puerto Rico restriction under contract terms.

Responsibilities

• Identify root causes through the intake process.
• Research claims to assess impact on issues.
• Identify opportunities for process improvements.
• Grow SME knowledge in claims processing and TRICARE rules.
• Meet performance expectations and deliver results.
• Support peers on root cause analysis and complex issues.
• Attend trainings to develop skills on complex topics.
• Pursue ongoing learning on TRICARE programs and reimbursement methods.
• Model integrity and meet commitments.

Skills

TRICARE claims processing

Data analysis

Customer communication

Communication and presentation

Citizenship required

Security clearance NBIS

Puerto Rico restriction

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims and policy inquiries, research rule accuracy, and collaborate with teammates to provide correct answers for customers.

The role emphasizes root cause analysis, ongoing training, and opportunities to become a claims SME. The position is remote with potential travel for training, with a 40-hour workweek and a starting pay range reflective of the market.