TRICARE Claims & Policy Specialist - Remote

Humana; Lansing (MI); Remoto; USD 54.000 - 73.000; Tempo pieno

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims, provide research-backed responses, and collaborate with care teams. Remote work with periodic travel to Humana offices may be required. The role emphasizes accuracy, process improvement, and SME development.

The candidate should have TRICARE experience, strong data skills, and the ability to communicate complex topics to senior leaders while meeting regulatory and security requirements.

Competenze

• 3+ years' TRICARE claims processing or research experience.
• 3+ years' data analysis for reports.
• Clear and concise written responses to inquiries.
• Excellent communication and presentation to leadership.
• U.S. citizenship required for DoD contract.
• Security clearance approval required (NBIS).
• Not authorized to hire in Puerto Rico under current contract.

Mansioni

• Lead root cause identification through intake processes.
• Research claims to assess impact on issues.
• Identify improvements from analyses.
• Develop SME level knowledge of claims processes.
• Meet expectations and drive results.
• Assist peers on complex topics and attend trainings.
• Maintain integrity and meet deadlines.

Conoscenze

TRICARE claims

Data analysis

Written communication

Executive leadership communication

U.S. citizenship

Security clearance

Puerto Rico restriction awareness

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims, provide research-backed responses, and collaborate with care teams. Remote work with periodic travel to Humana offices may be required. The role emphasizes accuracy, process improvement, and SME development.

The candidate should have TRICARE experience, strong data skills, and the ability to communicate complex topics to senior leaders while meeting regulatory and security requirements.