Remote TRICARE Claims & Policy Specialist

Humana; San Juan (PR); A distancia; USD 54.000 - 73.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Descripción de la vacante

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims processes, policy inquiries, and root-cause analysis. The role emphasizes research accuracy, cross-team collaboration, and adherence to federal requirements.

You will contribute to knowledge growth, respond to inquiries clearly, and support complex issues with a focus on quality service and compliance. Remote work is available with occasional travel for training.

Formación

• 3+ years of TRICARE contract experience in claims processing or related area.
• Experience analyzing data for reports and performance metrics.
• Strong written communication to respond to customer inquiries.
• Excellent verbal and presentation skills for senior leadership.

Responsabilidades

• Identify root causes through intake processes and document findings.
• Research claims to determine impact on reported issues and close knowledge gaps.
• Identify opportunities to improve processes based on data analysis.
• Develop SME level expertise in TRICARE claims and related policies.
• Maintain accountability by meeting established dates and delivering results.

Conocimientos

TRICARE claims processing

Provider research

Data analysis for reports

Written responses to inquiries

Executive level communication

Citizenship clearance (DoD NBIS)

Educación

Bachelor's degree

Herramientas

SQL

Descripción del empleo

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims processes, policy inquiries, and root-cause analysis. The role emphasizes research accuracy, cross-team collaboration, and adherence to federal requirements.

You will contribute to knowledge growth, respond to inquiries clearly, and support complex issues with a focus on quality service and compliance. Remote work is available with occasional travel for training.