Claims Process and Policy Professional
Core
Research TRICARE rules and regulations to answer claims and policy inquiries from beneficiaries, providers, and vendors; identify root causes of reported issues; analyze data to determine impact and improve claims processing.
Role type
Claims Process and Policy Professional
Builds
Accurate claims resolutions and policy guidance for TRICARE beneficiaries and providers
Domain
Healthcare / Government Contracting (TRICARE)
Deliverable
client delivery
Required skills
TRICARE rules and regulations knowledge, claims processing, data analysis, root cause identification, written communication
Preferred skills
SQL, claims processing experience, Bachelor's degree
Responsibilities
Research claims and policy issues for accuracy and completeness; Identify improvement opportunities based on analysis; Assist peers and SMEs on complex issues; Analyze data for reports
Seniority
Mid-level, 3+ years experience