TRICARE Claims & Policy Specialist (Remote)

Humana; Pierre (SD); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Medical, dental & vision benefits

401(k) retirement savings plan

Paid time off & holidays

Parental and caregiver leave

Disability and life insurance

Job summary

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims inquiries and policy questions from beneficiaries and providers. You will research for accuracy, apply TRICARE rules, and work with teammates to obtain correct information and answers.

The role emphasizes identifying root causes, performing claims research, and expanding knowledge to become a subject matter expert while maintaining high service standards in a remote setting.

Qualifications

• 3+ years of experience with TRICARE contract in claims processing or related benefit administration.
• 3+ years of experience analyzing data for reports.
• Experience providing clear, concise written responses to customer inquiries.
• Excellent communication and presentation skills for senior leadership.
• US citizenship required for this DoD contract.

Responsibilities

• Identify root causes through established intake processes and research claims to determine impact.
• Support SME on more complex issues and assist peers with root-cause analysis.
• Attend trainings to develop skills in TRICARE programs and reimbursement methodologies.
• Demonstrate integrity, meet commitments, and take responsibility for actions.
• Role may require other duties as assigned by supervisor.

Skills

TRICARE experience

Data analysis

Written communication

Communication & presentation

US citizenship

Security clearance NBIS

Puerto Rico restriction

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is seeking a Claims Process and Policy Professional 1 to handle TRICARE claims inquiries and policy questions from beneficiaries and providers. You will research for accuracy, apply TRICARE rules, and work with teammates to obtain correct information and answers.

The role emphasizes identifying root causes, performing claims research, and expanding knowledge to become a subject matter expert while maintaining high service standards in a remote setting.