TriWest Healthcare Alliance · 4 hours ago
Claims Correspondence QC Analyst
Phoenix, AZ
Full-time
Remote
Entry, Mid Level
$50K/yr - $52K/yr
2+ years exp
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Responsibilities
Works in CRM, reviewing outgoing and incoming cases, ensuring processes were followed.
Assist in conducting Daily/Weekly/Monthly audits of teams working in CRM.
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.
Develops and monitors reports and communications using CRM and Claims systems.
Assist in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
Assist with resolving claims quality issues by identifying, documenting, and communicating with management.
Assist with performing root cause analysis.
Provide subject matter expertise.
Performs other duties as assigned.
Regular and reliable attendance is required.
Qualification
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Required
High school diploma or G.E.D.
2 years’ experience working with healthcare claims, medical billing, or authorization data
Experience with researching and resolving escalated claims issues
Knowledge of claims functions including working understanding of claims payments and denials
Experience with IBM Dynamics (TriWest 360 CRM) or other CRM applications
Experience with Claims Systems
Preferred
Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field
Lead role over a process or team
Experience in interpreting policies, monitoring compliance, and developing processes
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
1,001-5,000 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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