TRICARE Claims & Policy Specialist - Remote

Humana, Inc.; Denver (CO); Remoto; USD 54.000 - 73.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional I to handle TRICARE claims research and policy inquiries. The role supports beneficiaries, providers and partners, requiring accurate, timely responses and ongoing learning to stay current with TRICARE rules and reimbursement methods.

Remote work is available, with occasional travel for training or meetings. A DoD contract mandates U.S. citizenship and NBIS clearance; a Bachelor's degree is preferred and SQL knowledge is a plus.

Competenze

• 3+ years of TRICARE contract experience in claims processing or related field.
• 3+ years of data analysis experience for reports.
• Clear, concise written responses to customer inquiries.
• Excellent communication and presentation skills for senior leadership.
• US citizenship required for DoD contract.
• Ability to obtain NBIS government security clearance.
• Not authorized to hire in Puerto Rico under government contract.

Mansioni

• Identify root causes via the intake process.
• Research claims to determine impact on reported issues.
• Identify improvement opportunities from analysis performed.
• Become a claims SME through ongoing learning.
• Meet established expectations and achieve results.
• Assist peers on root cause identification and complex issues.
• Attend required training to develop new skills.
• Attend trainings to increase TRICARE program knowledge and reimbursement understanding.
• Model integrity and meet commitment dates.

Conoscenze

TRICARE claims processing

Data analysis for reports

Clear written responses

Excellent communication to leadership

US citizenship for DoD contract

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional I to handle TRICARE claims research and policy inquiries. The role supports beneficiaries, providers and partners, requiring accurate, timely responses and ongoing learning to stay current with TRICARE rules and reimbursement methods.

Remote work is available, with occasional travel for training or meetings. A DoD contract mandates U.S. citizenship and NBIS clearance; a Bachelor's degree is preferred and SQL knowledge is a plus.