Remote TRICARE Claims & Policy Specialist

Humana, Inc.; Santa Fe (NM); Remote; USD 54,000 - 73,000; Full time

Job summary

Humana, Inc. seeks a Claims Process and Policy Professional 1 to handle TRICARE claims inquiries, research for accuracy, and resolve policy issues. The role supports an integrated remote team, with expectations to become SME and deliver results while working with internal partners and providers.

This position requires 3+ years TRICARE experience, data analysis skills, and strong written and verbal communication for senior leadership. U.S.

Qualifications

• 3+ years TRICARE claims experience.
• 3+ years data analysis for reports.
• Clear and concise written responses to customer inquiries.
• Excellent communication and ability to present to senior leadership.
• US citizenship required by DoD contract.
• Ability to obtain NBIS security clearance.
• HGB not authorized to work in Puerto Rico under contract.

Responsibilities

• Identify root causes through established intake process.
• Research claims to determine impact on reported issues.
• Identify opportunities for improvement based on analysis.
• Increase knowledge to become a TRICARE SME.
• Meet established expectations and achieve results.

Skills

TRICARE claims

Data analysis

Written responses

Executive communication

US citizenship

Security clearance NBIS

SQL

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. seeks a Claims Process and Policy Professional 1 to handle TRICARE claims inquiries, research for accuracy, and resolve policy issues. The role supports an integrated remote team, with expectations to become SME and deliver results while working with internal partners and providers.

This position requires 3+ years TRICARE experience, data analysis skills, and strong written and verbal communication for senior leadership. U.S.