TRICARE Claims & Policy Specialist - Remote

Humana; Oregon; Ibrido; USD 54.000 - 73.000; Tempo pieno

Descrizione del lavoro

Humana is seeking a Claims Process and Policy Professional 1 for a remote role in the United States. You will handle inquiries from beneficiaries, providers, vendors, and internal partners, researching TRICARE rules to provide accurate answers.

The position emphasizes a collaborative, compliant approach and ongoing learning to improve claims processing and customer outcomes. Required are 3+ years in TRICARE claims, data analysis, and strong written communication, with NBIS clearance and US

Competenze

• 3+ years of experience with TRICARE contract working with claims processing
• 3+ years of experience analyzing data for reports
• Experience providing clear and concise written responses to customer inquiries
• Excellent communication and presentation skills for senior leadership
• US citizenship is required for this position
• Successfully obtain government security clearance (NBIS)
• Not authorized to hire candidates living in Puerto Rico per government contract

Mansioni

• Identify root causes through established intake process
• Research claims to determine impact on reported issues
• Identify improvement opportunities based on analysis
• Become a claims SME through ongoing knowledge building
• Collaborate with peers and SMEs on complex issues

Conoscenze

Data analysis

Written communication

Communication skills

US citizenship

Formazione

Bachelor's degree

Strumenti

SQL

Descrizione del lavoro

Humana is seeking a Claims Process and Policy Professional 1 for a remote role in the United States. You will handle inquiries from beneficiaries, providers, vendors, and internal partners, researching TRICARE rules to provide accurate answers.

The position emphasizes a collaborative, compliant approach and ongoing learning to improve claims processing and customer outcomes. Required are 3+ years in TRICARE claims, data analysis, and strong written communication, with NBIS clearance and US