Claims Research Jobs (NOW HIRING)

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).
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
The Supervisor, Claims Administration is responsible for the daily oversight of a claims administration functional team handling requests related to Government claims. This position may manage one or more work types including, but not limited to, claims research, reconsideration, correspondence, inquiries & escalations, and audits. This role is responsible for ensuring individual and team performance expectations are met within their assigned claims function(s). The Supervisor, Claims Administration interacts and collaborates frequently with beneficiaries, Veterans, providers, sub-contractors, the Government, and internal business partners to resolve issues, respond to inquiries, and improve processes.
Education & Experience
Required:
• High School diploma or GED
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
• 4 years of healthcare claims, billing (or related healthcare area) experience
• 1 year in a Supervisory role or 2 years in a Team Lead (or equivalent) role
• Experience interpreting claims written policy and demonstrated understanding of automated transactions
• Demonstrated ability to communicate effectively, both verbally and in writing
Preferred:
• Associate degree or higher in related field
• Government claims experience
• Intermediate proficiency with MS Office suite, with an emphasis on Excel
• Knowledgeable of claims pricing methodologies
• Claims coding certification or equivalent experience
Key Responsibilities
• Assists in the development and implementation of department policies and training.
• Audits completed work, performs analysis of results, and provides coaching for improvement.
• Responsible for the daily supervision of staff, including multiple job roles.
• Manages assigned functional team(s), to include people, workflows, performance, and procedures.
• Proactively identifies opportunities and collaborates with leaders and subcontractors to drive issue resolution.
• Coordinates with leadership, direct reports, and project teams regarding process changes.
• Collaborates cross-functionally with internal business partners on process changes and improvements.
• Makes recommendations to improve quality and efficiency to enhance service to internal and external stakeholders.
• Exhibits professionalism in all written and verbal communication.
• Hires, evaluates, and develops team members.
• Assesses team performance, initiates corrective action plans, and writes annual reviews.
• Provides telephonic customer service assistance to Government employees, providers, Veterans, and beneficiaries.
• Performs other duties as assigned.
• Regular and reliable attendance is required.
Competencies
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; adapts to different styles; listens critically; collaborates.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
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, communicates clearly, and draws sound conclusions.
Leadership: Successfully manages different styles of employees; provides clear direction and effective coaching.
Multi-Tasking / Time Management: Prioritizes and manages actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjusts to priorities, learns 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:
• Works within a standard office environment, with minimal travel
• Extensive computer work with long periods of sitting
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
• 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

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $72,000 - $76,000 per year.
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.