TRICARE Claims & Policy Specialist (Remote)

Humana; Helena (MT); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Remote work option

Medical, dental and vision benefits

401(k) retirement savings

Paid time off and holidays

Job summary

Humana, Inc. is seeking a Claims Process and Policy Professional to handle TRICARE claims inquiries, research issues, and provide accurate, timely responses to beneficiaries, providers, and partners.

The role emphasizes data analysis, process improvement, and SME development while maintaining high standards of integrity and compliance. Remote work may be available to qualified candidates.

Qualifications

• 3+ years' TRICARE claims processing or contract experience.
• 3+ years' experience analyzing data for reports.
• Proven ability to provide clear written responses to customer inquiries.
• Excellent communication and presentation skills for senior leadership.
• U.S. citizenship is required due to DoD contract.
• Ability to obtain government security clearance (NBIS).
• Not authorized to hire in Puerto Rico due to government contract.

Responsibilities

• Identify root causes through intake processes and perform claims research.
• Assist peers on root cause identification and train on complex topics.
• Stay updated on TRICARE program rules and reimbursement methodologies.
• Model integrity, meet commitments, and take responsibility.

Skills

TRICARE claims processing

Data analysis for reports

Clear written responses to inquiries

Communication and presentation

US citizenship

NBIS security clearance

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional to handle TRICARE claims inquiries, research issues, and provide accurate, timely responses to beneficiaries, providers, and partners.

The role emphasizes data analysis, process improvement, and SME development while maintaining high standards of integrity and compliance. Remote work may be available to qualified candidates.