TRICARE Claims & Policy Specialist (Remote)

Humana; Providence (RI); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Remote work

Occasional travel

Job summary

Humana, Inc. is hiring for a Claims Process and Policy Professional 1 in a remote role across the United States. You will research TRICARE rules, resolve inquiries from beneficiaries and providers, and collaborate with internal partners to obtain complete information.

The role emphasizes root-cause analysis, SME development, and high-quality written responses, with travel only as needed for training or meetings.

Qualifications

• 3+ years of TRICARE contract work with claims processing or provider research.
• 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 and executive leadership.

Responsibilities

• Identify root causes through the intake process and perform claims research to determine impact.
• Propose and participate in improvements based on analysis and SME knowledge.
• Maintain up-to-date knowledge to become a claims subject matter expert (SME) and meet performance expectations.
• Assist peers on complex issues and participate in required training.

Skills

TRICARE claims experience

Data analysis for reports

Clear written responses

Communication skills

U.S. citizenship required

Security clearance NBIS

Education

Bachelor's degree

Tools

SQL

Job description

Humana, Inc. is hiring for a Claims Process and Policy Professional 1 in a remote role across the United States. You will research TRICARE rules, resolve inquiries from beneficiaries and providers, and collaborate with internal partners to obtain complete information.

The role emphasizes root-cause analysis, SME development, and high-quality written responses, with travel only as needed for training or meetings.