What are the responsibilities and job description for the Claims Correspond QC Analyst position at TriWest Healthcare Alliance?
Profile
We offer remote work opportunities (AK, AR, AZ, 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).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
The Claims Correspondence Quality Control Analyst supports the Claims Customer Service and Written Correspondence teams. The analyst performs quality control activities on CRM cases that have been entered and processed by Claims CSRs, Claims Reviewers, and Claims Processor. The analyst ensures the integrity and quality of the CRM cases, verifying the accuracy of the requests being sent between TriWest departments and the Claims Processor. The analyst coordinates the internal review and audit process including assisting in monitoring production and quality goals and standards for performance; identifies process improvements to enhance CRM and staff quality standards.
Education & Experience
Required:
Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
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 is required.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Information Management: Ability to manage large amounts of complex information easily, communicate 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.
Technical Skills: Expertise with healthcare claims processing and claims research; Government healthcare claims experience; Ability to document trends and assimilate data.
Working Conditions
Working Conditions
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:
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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.
We offer remote work opportunities (AK, AR, AZ, 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).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
The Claims Correspondence Quality Control Analyst supports the Claims Customer Service and Written Correspondence teams. The analyst performs quality control activities on CRM cases that have been entered and processed by Claims CSRs, Claims Reviewers, and Claims Processor. The analyst ensures the integrity and quality of the CRM cases, verifying the accuracy of the requests being sent between TriWest departments and the Claims Processor. The analyst coordinates the internal review and audit process including assisting in monitoring production and quality goals and standards for performance; identifies process improvements to enhance CRM and staff quality standards.
Education & Experience
Required:
- High school diploma or G.E.D. o 2 years’ experience working with healthcare claims, medical billing, or authorization data o Experience with researching and resolving escalated claims issues o Knowledge of claims functions including working understanding of claims payments and denials o Experience with IBM Dynamics (TriWest 360 CRM) or other CRM applications o Experience with Claims Systems
- Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field o Lead role over a process or team
- Experience in interpreting policies, monitoring compliance, and developing processes
- Works in CRM, reviewing outgoing and incoming cases, ensuring processes were followed. o Assist in conducting Daily/Weekly/Monthly audits of teams working in CRM. o Collaborate with multiple business partners including but not limited to Claims Management, Claims Customer Service, Project Management, Provider Services, outside/external vendors, to create strategies for process improvements. o Develops and monitors reports and communications using CRM and Claims systems. o Assist in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management. o Assist with resolving claims quality issues by identifying, documenting, and communicating with management. o Assist with performing root cause analysis. o Provide subject matter expertise. o Performs other duties as assigned. o Regular and reliable attendance is required.
Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.
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 is required.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Information Management: Ability to manage large amounts of complex information easily, communicate 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.
Technical Skills: Expertise with healthcare claims processing and claims research; Government healthcare claims experience; Ability to document trends and assimilate data.
Working Conditions
Working Conditions
- Availability to work any shift o Works within a standard office environment, with minimal travel
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
- 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
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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.
Salary : $49,000 - $54,000
