[Hiring] Claims Process and Policy Professional @Humana

Role Description

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 to 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
  • Identify 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

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

Work Style

• Remote
• Work at Home Requirements:
  • Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required
  • Wireless, wired cable or DSL connection is suggested
  • 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

Benefits

• Humana, Inc. and its affiliated subsidiaries offer 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
• 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

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.