TRICARE Claims & Policy Specialist (Remote)

Humana; Juneau (AK); Remoto; USD 54.000 - 73.000; Tempo pieno

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional I for remote work in the United States. The role involves researching TRICARE claims, identifying root causes, and providing accurate responses to inquiries while collaborating with a cross-functional team.

Responsibilities include analyzing data for reports, SME development, and maintaining knowledge of TRICARE programs. Occasional travel to Humana offices may be required; 40-hour work week and competitive benefits apply.

Competenze

• 3+ years of TRICARE claims processing experience.
• Experience analyzing data for reports.
• Clear written responses to customer inquiries.
• Strong communication and executive-level presentation skills.
• U.S. citizenship required by DoD contract.
• Ability to obtain government security clearance (NBIS).
• Not authorized to hire in Puerto Rico per contract.

Mansioni

• Identify root cause through intake process and document findings.
• Research claims to determine impact on reported issues.
• Identify improvement opportunities from analysis.
• Become a claims SME through knowledge expansion.
• Meet established expectations and deliver results.
• Assist peers on more complex issues and identify root causes.
• Attend trainings to develop skills for complex topics.
• Maintain knowledge of TRICARE program and reimbursement methods.
• Model integrity and meet commitment dates.

Conoscenze

TRICARE claims experience

Data analysis for reports

Clear written communication

Executive-level presentation skills

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional I for remote work in the United States. The role involves researching TRICARE claims, identifying root causes, and providing accurate responses to inquiries while collaborating with a cross-functional team.

Responsibilities include analyzing data for reports, SME development, and maintaining knowledge of TRICARE programs. Occasional travel to Humana offices may be required; 40-hour work week and competitive benefits apply.