Senior Claims Reviewer- VA & TW Internal Claims Queries at TriWest Healthcare Alliance in Phoenix, Arizona

Job Description:

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Performs research to assess root cause of moderate to high complexity claims issues and escalations. Conducts root cause and impact analyses as needed. Logs claims issues and tracks status and activities to ensure timely End-to-End (E2E) issue resolution. Regularly engages with the claims subcontractor and internal business partners to provide and receive status updates, obtain required data, and confirm resolution. Evaluates claims data and trend reports regularly to proactively identify provider billing issues, system issues, and/or improvement opportunities.

Education & Experience

Required:

• High School diploma or GED
• 5 years of healthcare claims, billing (or related healthcare area) experience
• 1 year of experience performing claims-related research
• Intermediate proficiency with MS Office suite, with an emphasis on Excel
• Knowledgeable of claims processing and medical management systems

Preferred:

• Bachelor's (BS/BA) Degree in healthcare or related field, or equivalent experience
• 1 to 2 years conducting claims-related data analysis
• 2 years of Government claims experience
• Quality or Process Improvement experience
• Knowledgeable of Root Cause Analysis concepts and methodologies
• Experience with Facets and/or CareRadius systems

Key Responsibilities

• Serves as subject matter expert resource to department and internal business partners
• Communicates issues and status updates to Manager and all appropriate stakeholders
• Partners with claims subcontractor, department management and peer team, and/or internal business partners on process improvements and issue resolution
• Conducts moderate to high complexity claims research, including root cause and impact analysis
• Logs and monitors issues E2E, following up on related activities in an appropriate and timely manner
• Communicates appropriately and effectively, using verbal and written channels
• Performs other duties as assigned
• Regular and reliable attendance required

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach

Information Management: Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment. Has a realistic understanding of relevant issues

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment

Technical Skills: Advanced analytical skills. Knowledge of fundamentals of accounting and sound business processes. Extensive Knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred. Research and project management skills

Working Conditions

Working Conditions:

• Favorable working conditions in a climate controlled office space
• Ability to stand and speak for long periods of time
• Must be available for to cover any work shift
• Works within an office environment with some travel required

Company Overview

Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®!

Our job is to make sure that America's heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

Benefits

We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage


• Generous paid time off


• 401(k) Retirement Savings Plan (with matching)


• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance


• Tuition reimbursement


• Paid volunteer time

*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $58,837.50- $62,106.25 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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