TriWest Healthcare Alliance · 18 hours ago
Claims Escalation Rep
Phoenix, AZ
Full-time
Remote
Entry Level
$48K/yr - $50K/yr
1+ years exp
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Responsibilities
Reviews, analyzes and directs resolution of complex claims issues.
Interfaces with Claims and CCOPs leaders, CSRs, other internal departments, VA and vendors.
Serves as a Subject Matter Expert to Claims Customer Service Representatives and other internal departments.
Investigates recurring problems, identifying process improvements and reporting findings to leadership.
Tracks daily questions and resolution trends.
Documents all communications involving staff, Veteran, and provider contacts.
Reviews large amounts of complex information from multiple sources, including validating appropriate data on claim.
Collaborates with Claims sub-contractor to build or update authorization and provider records.
Participates in training documentation creation and updates.
Manages multiple task lists in accordance within directed timelines.
Maintains updated knowledge of software applications, Claims trends, and Claim CSRs’ procedures and processes.
Complies with HIPAA regulations to protect privacy of health information.
Consistently meets department productivity and performance metrics.
Manages and prioritizes daily workflow queues to ensure timeliness standards are met.
Identifies and reports any potential quality or fraud issues to management.
Practices professional and concise communication in writing and by phone.
Performs other duties as assigned.
Regular and reliable attendance is required.
Qualification
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Required
High School diploma or G.E.D.
One year experience working in a call center
Proficient with Microsoft Outlook, Word and Excel
Strong Knowledge of medical terminology
2 years claims resolution, billing experience or demonstrated success as a TriWest Claims Customer Service Representative
Strong written and verbal communication skills
Preferred
Associates degree in healthcare or related field
Benefits
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
Company
TriWest Healthcare Alliance
TriWest Healthcare Alliance - Serving Those Who Serve. At TriWest, we honor the sacrifice and service of our nations military families by
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Mark E. Babbitt
Senior Advisor to President & CEO
Joseph Oddo
Vice President and Chief Information Officer
Recent News
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