Risk Management Professional
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • Kentucky, Montana, New York, North Carolina, Oklahoma • 🇺🇸 United States
Visit company websiteSalary
💰 $65,000 - $88,600 per year
Job Level
JuniorMid-Level
About the role
- responsible for ensuring payment quality of claims in accordance with TRICARE policy requirements
- reviewing pre-payment, high dollar claims to assess payment accuracy and identify potential claim payment risks
- provide accurate, actionable, and thorough feedback by completing high-dollar pre-pay reviews daily
- Audit results shared with operational areas to help mitigate organizational risk
- Utilize strong analytical, technical, and communication skills to conduct daily high dollar claim quality audit reviews
- making approval and processing determinations for payment release, conducting focused claim studies
- performing duplicate claim detection through the DHA Duplicate Claims System (DCS)
- research and review claims for internal focus audits to identify potential payment error risks
Requirements
- U.S. Citizenship
- Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)
- 2 years TRICARE claims experience to include professional and institutional claims reimbursement
- Strong knowledge of TRICARE policy and claims processing
- Able to work 8 hour shift between the hours of 7 a.m. - 6 p.m. E.T.
- Bachelor’s degree (preferred)
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
- many other opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingpayment accuracyduplicate claim detectionhigh dollar claims reviewaudit reviewrisk assessmentTRICARE policy knowledgeclaims reimbursement
Soft skills
analytical skillscommunication skills
Certifications
government security clearanceBachelor’s degree