Humana · 6 hours ago
Claims Process & Policy Professional
United States
Full-time
Remote
Mid Level
$54K/yr - $73K/yr
3+ years expHumana is committed to putting health first and is seeking a Claims Process and Policy Professional to join their team. This role involves researching claims and policy issues, ensuring accuracy and compliance with TRICARE rules and regulations, and identifying improvement opportunities in claims processing.
Health CareHealth InsuranceInsuranceVenture Capital
No H1B
Security Clearance RequiredU.S. Citizen Only
Responsibilities
Ensure appropriate identification of root cause through established intake process
Performs claims research to determine impact to reported issues
Identified improvement opportunities based on analysis performed
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
Qualification
Required
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
Preferred
Bachelor's degree
Experience processing TRICARE claims
Experience with SQL
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
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