$53,700 - $72,600 py; not specified; not specified
Hybrid
Tricare rules and regulations
Root cause identification
Claims research
CarePlus Health Plans Inc is seeking a Claims Process & Policy Professional to assist with inquiries related to claims and policy issues, ensuring compliance with TRICARE rules. The ideal candidate should have at least three years of experience with TRICARE claims processing and data analysis, along with excellent communication skills
Job Summary
You will ensure appropriate identification of root cause through established intake process.
You will perform claims research to determine impact to reported issues.
Humana offers competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, and a 401(k) retirement savings plan.
Matching Summary
Match Score: 85
CarePlus Health Plans Inc is seeking a Claims Process & Policy Professional to assist with inquiries related to claims and policy issues, ensuring compliance with TRICARE rules. The ideal candidate should have at least three years of experience with TRICARE claims processing and data analysis, along with excellent communication skills.
Salary
$53,700 - $72,600 per year; Not specified; Not specified
Skills & Requirements
Must-have
TRICARE rules and regulations
Root cause identification
Claims research
Improvement opportunity identification
Subject matter expert development
Nice-to-have
Assistance to peer group
Complex issue support
Key Requirements
3 years experience with TRICARE contract
3 years experience analyzing data for reports
Experience presenting data findings to leadership
Experience providing clear and concise written responses
Must be able to work 8 - 5 p.m. in Eastern time zone
U.S. Citizenship required
Interim approval for government security clearance
Work Rights
Must have US citizenship and interim security clearance