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Claims Process & Policy Professional
Humana
Pennsylvania, United States
Position Overview The Claims Process and Policy Professional reports to the Director of Process Improvement. You will receive inquiries arou...
$54k – $73k/year Apply Now
Cruise Booking Agent | Work From Home
Aisles & Abroad
New York, United States
Position Overview We are seeking service-oriented and detail-focused individuals to join our team as a Cruise Booking Agent. This role focus...
$45k – $70k/year Apply Now
Special Agent: Cybersecurity/Technology Expertise
Federal Bureau of Investigation (FBI)
New Haven County, CT
Position Overview Use your cybersecurity background to become an FBI special agent. Transition from technology to special agent to upskill a...
$103k – $133k/year Apply Now
Remote Insurance Verification Specialist, Specialty (Florida)
Walgreens
Orlando, FL
Responsible for verifying patient eligibility, coordinating benefits, running test claims, and determining patient coverage/responsibility fo...
$16.50 – $22.00/hr Apply Now
Fitness Front Desk Agent
Longboat Key Club
Longboat Key, FL
Join The Resort at Longboat Key Club as a Fitness Front Desk Agent, where you will be the welcoming face for our private club members. I...
$16.00 – $16.00/hr Apply Now
Supervisory Criminal Investigator (Supv Special Agent (CS/SS) NTE 1 Year/MBE/MBP)
CI - Criminal Investigation (USDT)
Anchorage, Alaska
About this job Summary Job overview Click on "Learn more about this agency" button below to view Eligibilities being considered an...
$126k – $126k/year Apply Now
Call Center Agent
Seronda Network
Phoenix, AZ
About Us: At Seronda Networks, we provide innovative solutions that drive success for our clients, while fostering a collaborative environmen...
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Front Desk Agent
The Portland Regency Hotel & Spa
Portland, ME
Join one of Portland's most iconic hospitality destinations. The Portland Regency Hotel & Spa, a beautiful Historic Hotel of America located ...
$18.00 – $18.00/hr Apply Now
Front Desk Agent
HVMG - Hospitality Ventures Management Group
St Augustine, FL
Position Overview As a Front Desk Agent, you will be the first point of contact for guests, providing warm, professional service throughout ...
$16.50 – $17.50/hr Apply Now
Call Center Agent
Seronda Network
Fort Worth, TX
At Seronda Networks, we provide cutting-edge solutions and offer a work environment where you can grow professionally, collaborate with passi...
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Claims Process & Policy Professional

Position Overview The Claims Process and Policy Professional reports to the Director of Process Improvement. You will receive inquiries around claims and policy issues from beneficiaries,...

$54k – $73k/year Apply Now

Position Overview
  • The Claims Process and Policy Professional reports to the Director of Process Improvement. You will receive inquiries around claims and policy issues from beneficiaries, providers, vendors, internal partners, and external participants that will need to be researched for accuracy and completeness regarding TRICARE rules and regulations.
Key Responsibilities
  • 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.
  • Continue increasing 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.
Required Qualifications
  • 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 Qualifications
  • Bachelor's degree.
  • Experience processing TRICARE claims.
  • Experience with SQL.
Work At Home Requirements
  • To ensure Hybrid Office/Home associates' ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable, or DSL connection is suggested.
  • Satellite, cellular, and microwave connection can be used only if approved by leadership.
  • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  • 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
  • $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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Humana
  • 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.
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.
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