Claims Process & Policy Professional

Humana

3d • Hybrid

About The Position

Become a part of our caring community The Claims Process and Policy Professional reports to the Director of Process Improvement. You will receive inquires around claims and policy issues from beneficiaries, providers, vendors, internal partners and external participate that will need to be researched for accuracy and completeness regarding our TRICARE rules and regulations. Key Accountabilities - You will ensure appropriate identification of root cause through established intake process You will perform claims research to determine impact to reported issues You will identify improvement opportunities based on analysis performed You will continue increasing in knowledge to become a claims subject matter expert (SME) You will provide assistance as needed to peer group on root cause identification and assist Claims SMEs as needed on more complex issues Use your skills to make an impact

Requirements

• Our Department of Defense contract requires U.S. Citizenship for this role
• Must successfully receive interim approval for government security clearance (NBIS- National Background Investigation Services)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.
• 3 years experience with TRICARE contract working with claims processing, provider research and/or administering the benefit.
• 3 years experience analyzing data for reports
• Experience presenting data findings to leadership
• Experience providing clear and concise written responses to customer inquiries
• Must be able to work 8 - 5 p.m. in Eastern time zone
• To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours 40

Nice To Haves

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

Responsibilities

• 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
• Continue increasing in knowledge to become a claims subject matter expert (SME)
• Provide assistance as needed to peer group on root cause identification and assist Claims SMEs as needed on more complex issues

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees