Claims Process and Policy Professional 1

We are seeking a Claims Process and Policy Professional 1 to join our team. As a Claims Process and Policy Professional, you will play a critical role in ensuring that our customers receive accurate and timely information about their claims and policies.

Job Summary: The Claims Process and Policy Professional 1 work assignments are often straightforward and of moderate complexity. You will receive inquiries around claims and policy issues from beneficiaries, providers, vendors, internal partners, and external participation. Your primary responsibility will be to research and provide accurate and complete information regarding TRICARE rules and regulations.

Key Accountabilities:

• Ensure appropriate identification of root cause through established intake process
• Perform claims research to determine impact to reported issues
• Identify improvement opportunities based on analysis performed
• Increase knowledge to become a claims subject matter expert (SME)
• Meet established expectations and achieve results
• Assist peer group on root cause identification and assist Claims SMEs on more complex issues
• Attend required training to develop new skills around more complex topics
• Model and inspire integrity, meet commitment dates, and take responsibility for your own actions

Requirements:

• 3 years or more years of experience with TRICARE contract working with claims processing, provider research, or administering the benefit
• 3 years or more years of experience analyzing data for reports
• Experience providing clear and concise written responses to customer inquiries
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
• U.S. citizenship
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)

Preferred Qualifications:

• Bachelor's degree
• Experience processing TRICARE claims
• Experience with SQL

Work Style: Remote

Scheduled Weekly Hours: 40

Pay Range: $53,700 - $72,600 per year

Benefits: Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, short-term and long-term disability, life insurance, and many other opportunities.