Remote TRICARE Claims & Policy Specialist

Humana; Richmond (VA); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana, Inc. is seeking a Claims Process and Policy Professional I to handle TRICARE claims research, policy inquiries, and inquiries from beneficiaries, providers, vendors, and partners.

You will research for accuracy and completeness regarding TRICARE rules and regulations and adapt to an integrated environment to provide accurate customer responses. The role emphasizes root-cause analysis, becoming a claims SME, and delivering concise written communications to leadership, with remote work

Qualifications

• 3+ years of experience with TRICARE contract working with claims processing or provider research
• 3+ years of experience analyzing data for reports
• Experience providing clear written responses to customer inquiries
• Excellent communication skills for senior/executive leadership
• US citizenship required for DoD contract
• Successful NBIS clearance approval
• Not authorized to hire candidates in Puerto Rico under government contract

Responsibilities

• Identify root causes through intake process and claims research
• Increase knowledge to become a claims SME
• Meet established expectations and deliver results
• Assist peers on complex issues and participate in training
• Learn how TRICARE program and reimbursement methods affect daily work
• Model integrity and responsible action

Skills

TRICARE claims

Data analysis

Customer responses

Executive communication

US citizenship

Security clearance NBIS

SQL

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional I to handle TRICARE claims research, policy inquiries, and inquiries from beneficiaries, providers, vendors, and partners.

You will research for accuracy and completeness regarding TRICARE rules and regulations and adapt to an integrated environment to provide accurate customer responses. The role emphasizes root-cause analysis, becoming a claims SME, and delivering concise written communications to leadership, with remote work