Remote TRICARE Claims & Policy Specialist

Humana; Trenton (NJ); Remote; USD 54,000 - 73,000; Full time

Job summary

Humana, Inc. seeks a Claims Process and Policy Professional 1 to manage TRICARE claims processing and policy inquiries. You will research for accurate TRICARE rule application and coordinate with teams to obtain needed information for customers.

The role emphasizes growing as a TRICARE SME, delivering accurate responses, and maintaining high standards of integrity while supporting travel-ready training and remote work options.

Qualifications

• 3+ years of TRICARE claims processing experience
• 3+ years of experience analyzing data for reports
• Ability to provide clear and concise written responses to customer inquiries
• Excellent communication and presentation skills to explain technical details to senior and executive level leadership
• U.S. citizenship for this Department of Defense contract
• Successful approval for government security clearance NBIS
• Puerto Rico cannot be considered due to government contract restrictions

Responsibilities

• Identify root cause through intake process
• Perform claims research to determine impact
• Identify improvement opportunities based on analysis
• Increase knowledge to become a TRICARE claims SME
• Meet established expectations and deliver results
• Assist peers on root cause identification and more complex issues
• Attend required training to develop new skills
• Learn how the TRICARE program and reimbursement methodologies impact daily work
• Model integrity, meets commitment dates and takes responsibility for actions

Skills

TRICARE claims processing

Data analysis for reports

Written responses to inquiries

Communication to leadership

U.S. citizenship for clearance

NBIS clearance

Puerto Rico restriction

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. seeks a Claims Process and Policy Professional 1 to manage TRICARE claims processing and policy inquiries. You will research for accurate TRICARE rule application and coordinate with teams to obtain needed information for customers.

The role emphasizes growing as a TRICARE SME, delivering accurate responses, and maintaining high standards of integrity while supporting travel-ready training and remote work options.