TRICARE Claims & Policy Specialist (Remote)

Humana; Annapolis (MD); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Remote work

Training opportunities

Travel as needed

Job summary

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle routine to moderately complex inquiries from beneficiaries, providers, and partners. You will research TRICARE rules, ensure accurate responses, and grow as a claims SME in a remote work setting.

You will apply data analysis, clear written communication, and strong collaboration to support quick, accurate resolutions while complying with security requirements and government contracts.

Qualifications

• 3+ years TRICARE contract experience with claims processing, provider research or administering the benefit.
• 3+ years 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.
• U.S. citizenship required for this Department of Defense contract.
• Successful NBIS security clearance is required.
• Not eligible to hire candidates living in Puerto Rico per government contract.

Responsibilities

• Identify root causes through established intake process and perform claims research.
• Assist peers and SMEs on complex issues; participate in required trainings to develop new skills.
• Attend trainings to expand knowledge of TRICARE program and reimbursement methodologies.
• Model integrity, meet commitment dates and take responsibility for actions.

Skills

TRICARE experience

Data analysis

Customer communication

NBIS clearance

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle routine to moderately complex inquiries from beneficiaries, providers, and partners. You will research TRICARE rules, ensure accurate responses, and grow as a claims SME in a remote work setting.

You will apply data analysis, clear written communication, and strong collaboration to support quick, accurate resolutions while complying with security requirements and government contracts.