TRICARE Claims & Policy Specialist - Remote

Humana; Atlanta (GA); Remoto; USD 54.000 - 73.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work

Travel for training

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional 1 for a remote role supporting TRICARE-based claims processing and policy inquiries.

You will research to ensure accuracy, handle inquiries from beneficiaries, providers, and partners, and work with the team to resolve issues in compliance with TRICARE rules. Essential duties include root-cause analysis, research to assess impact, and continuous learning to deepen TRICARE program knowledge.

Competenze

• Three or more years of experience with TRICARE contract working with claims processing, provider research or administering the benefit.
• Three 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.
• U.S. citizenship is required for this Department of Defense contract.
• Ability to obtain government security clearance (NBIS).
• HGB restriction: not authorized to hire in Puerto Rico.

Mansioni

• Identify root cause through established intake process.
• Research claims to determine impact to reported issues.
• Identify and implement improvement opportunities based on analysis.
• Increase knowledge to become a claims SME.
• Meet established expectations and achieve results.
• Assist peers with root cause analysis and more complex issues.
• Attend required training to develop advanced skills.
• Participate in trainings to expand knowledge in TRICARE and reimbursement methodologies.
• Model integrity, meet commitments, and take responsibility for actions.

Conoscenze

TRICARE claims processing

Data analysis

Customer inquiries response

Communication skills

Security clearance

US citizenship

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional 1 for a remote role supporting TRICARE-based claims processing and policy inquiries.

You will research to ensure accuracy, handle inquiries from beneficiaries, providers, and partners, and work with the team to resolve issues in compliance with TRICARE rules. Essential duties include root-cause analysis, research to assess impact, and continuous learning to deepen TRICARE program knowledge.