Remote TRICARE Claims & Policy Specialist

Humana; Madison (WI); Remoto; USD 54.000 - 73.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work

Travel may be required

Descrizione del lavoro

Humana, Inc. in the United States seeks a Claims Process and Policy Professional to handle TRICARE claims inquiries, research policy interpretations, and provide precise, compliant responses to beneficiaries, providers and partners in a remote work environment.

The role emphasizes root-cause analysis, data review for reports, continuous learning about TRICARE rules, and collaboration with colleagues to resolve issues while upholding security standards; occasional travel to Humana offices may be

Competenze

• 3 years or more years of experience with TRICARE contract working with claims processing, provider research or administering the benefit
• 3 years or more years of experience analyzing data for reports
• Experience providing clear and concise written responses to customer inquiries
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

Mansioni

• Identify root cause through established intake process
• Perform claims research to determine impact to reported issues
• Identify improvement opportunities based on analysis performed
• Increase knowledge to become a claims subject matter expert (SME)
• Meet established expectations and achieve results
• Assist peer group on root cause identification and assist Claims SMEs on more complex issues
• Attend required training to develop new skills around more complex topics
• Attend training opportunities to increase their knowledge in other areas that improve the claims processing area
• Seek continued learning to understand how the TRICARE program and reimbursement methodologies impact their daily work
• Model and inspire integrity, meets commitment dates, and takes responsibility for their own actions

Conoscenze

TRICARE claims

Data analysis

Written responses

Executive communication

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. in the United States seeks a Claims Process and Policy Professional to handle TRICARE claims inquiries, research policy interpretations, and provide precise, compliant responses to beneficiaries, providers and partners in a remote work environment.

The role emphasizes root-cause analysis, data review for reports, continuous learning about TRICARE rules, and collaboration with colleagues to resolve issues while upholding security standards; occasional travel to Humana offices may be