Remote TRICARE Claims Policy Specialist

Humana, Inc.; Topeka (KS); Remoto; USD 54.000 - 73.000; Tempo pieno

Descrizione del lavoro

Humana, Inc. seeks a Claims Process and Policy Professional to handle TRICARE claims processing questions, perform root-cause analyses, research pay policies, and become a subject matter expert in the claims area. The role emphasizes accuracy, clear written communication, and collaboration with cross-functional teams.

Remote work is available; occasional travel to Humana offices may be required for training. Applicants must meet DoD contract citizenship and NBIS clearance requirements.

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 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 the intake process and relate to claims.
• Perform claims research to determine impact to reported issues.
• Identify improvement opportunities based on analysis performed.
• Increase knowledge to become a claims 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 knowledge in other areas that improve the claims processing area.
• Seek continued learning to understand how the TRICARE program and reimbursement methodologies impact daily work.
• Model and inspire integrity, meet commitment dates, and take responsibility for own actions.

Conoscenze

TRICARE claims processing

Data analysis for reports

Clear written responses to inquiries

Communication and presentation skills

Security clearance NBIS eligibility

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. seeks a Claims Process and Policy Professional to handle TRICARE claims processing questions, perform root-cause analyses, research pay policies, and become a subject matter expert in the claims area. The role emphasizes accuracy, clear written communication, and collaboration with cross-functional teams.

Remote work is available; occasional travel to Humana offices may be required for training. Applicants must meet DoD contract citizenship and NBIS clearance requirements.