Claims Risk Management Professional - Remote

Overview

The Claims Risk Management Professional is responsible for ensuring payment quality of claims in accordance with TRICARE policy requirements, reviewing high dollar claims to assess payment accuracy and identify potential risks.

In Short

• Conduct daily high dollar claim quality audit reviews.
• Make approval and processing determinations for payment release.
• Research claims for internal focus audits to identify potential payment error risks.
• Develop and recommend controls to minimize claims processing risks.
• Perform advanced administrative support duties.
• Assist in special projects as directed by management.
• Must have strong knowledge of TRICARE policy and claims processing.
• Work from home with specific internet requirements.
• Occasional travel to Humana's offices may be required.
• Eligible for a bonus incentive plan based on performance.

Requirements

• 2 years TRICARE claims experience.
• U.S. Citizenship required.
• Interim approval for government security clearance needed.
• Strong analytical and communication skills.
• Ability to work independently with discretion and judgment.
• Preferred Bachelor's degree.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and other opportunities.