Remote TRICARE Claims & Policy Specialist

Humana; United States; Remote; USD 54,000 - 73,000; Full time

Job summary

Humana is seeking a Claims Process and Policy Professional to support TRICARE benefits remotely. The role handles inquiries from beneficiaries, providers, and partners, researches claims for accuracy, and ensures correct application of TRICARE rules.

The position emphasizes collaboration with team members to gather information and deliver precise responses. This role is remote with a 40-hour workweek and includes occasional travel to Humana offices for training or meetings.

Qualifications

• 3+ years of TRICARE claims processing or related benefits work.
• 3+ years of data analysis for reports.
• Ability to provide clear written responses to customer inquiries.
• Excellent communication and presentation skills for senior leadership.
• US citizenship is required for this Department of Defense contract.
• Ability to obtain government security clearance via NBIS.
• HGB contract restricts hiring in Puerto Rico.

Responsibilities

• Identify root causes through the intake process.
• Research claims to determine impact on reported issues.
• Identify improvement opportunities based on analysis.
• Become a TRICARE subject matter expert (SME).
• Meet expectations and deliver results.

Skills

TRICARE claims processing

Data analysis for reports

Written responses to inquiries

Communication to leadership

US citizenship required

NBIS security clearance

Puerto Rico exclusion

Education

Bachelor’s degree

Tools

SQL

Job description

Humana is seeking a Claims Process and Policy Professional to support TRICARE benefits remotely. The role handles inquiries from beneficiaries, providers, and partners, researches claims for accuracy, and ensures correct application of TRICARE rules.

The position emphasizes collaboration with team members to gather information and deliver precise responses. This role is remote with a 40-hour workweek and includes occasional travel to Humana offices for training or meetings.