044 CenterWell Pharmacy, Inc. is looking for a Risk Management Professional to ensure payment quality and mitigate organizational risk. In this role, you’ll be central to maintaining accuracy and compliance with TRICARE policy requirements.
What You'll Do
- Utilize analytical and communication skills to conduct daily high-dollar claim quality audit reviews.
- Make approval and processing determinations for payment release.
- Conduct focused claim studies and perform duplicate claim detection through the DHA Duplicate Claims System (DCS).
- Research and review claims for internal focus audits to identify payment error risks and system issues.
- Develop and recommend controls and cost-effective approaches to minimize claims processing risks.
- Perform advanced administrative, operational, and customer support duties requiring independent initiative.
- Assist in special projects as directed by Department Management.
What We're Looking For
- U.S. Citizenship (Department of Defense contract requirement).
- Ability to successfully receive interim approval for a government security clearance (NBIS).
- Cannot be living in Puerto Rico per government contract.
- 2 years of TRICARE claims experience, including professional and institutional claims reimbursement.
- Strong knowledge of TRICARE policy and claims processing.
- Able to work an 8-hour shift between 7 a.m. - 6 p.m. E.T.
Nice to Have
- Bachelor’s degree.
Technical Stack
- DHA Duplicate Claims System (DCS)
Benefits & Compensation
- Compensation: $65,000 - $88,600 per year.
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
- Short-term and long-term disability, and life insurance.
Work Mode
This is a fully remote position.
Humana is an equal opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.
