Claims Process and Policy Professional

Become a part of our caring community

The Claims Process and Policy Professional 1 work assignments are often straightforward and of moderate complexity. The Claims Process and Policy Professional will receive inquiries around claims and policy issues from beneficiaries, providers, vendors, internal partners and external participation. You will research for accuracy and completeness regarding our TRICARE rules and regulations. Must have a good working knowledge of the rules and regulations and be able to work with other team members to get additional information.

The Claims Process and Policy Professional will adapt to an integrated work environment to get the correct answers for our customers in order answer all inquiries fully and accurately.

KEY ACCOUNTABILITIES

50%

• Ensure appropriate identification of root cause through established intake process
• Perform claims research to determine impact to reported issues
• Identified improvement opportunities based on analysis performed
• Increase knowledge to become a claims subject matter expert (SME)
• Meet established expectations and achieve results

40%

• 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.
• Attend training opportunities to increase their knowledge in other areas that improve the claims processing area
• Seek continued learning to understand how the TRICARE program and reimbursement methodologies impact their daily work

10%

• Model and inspire integrity, meets commitment dates, and takes responsibility for their own actions

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.

Use your skills to make an impact

Required Qualifications

• 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
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• 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

Preferred Qualifications

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

Additional Information

Work Style: Remote

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$53,700 - $72,600 per year

Description of 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 11-20-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.