Claims Correspond Qc Analyst

REMOTE - Work From Home Opportunity !

Candidates must live in one of the following states to be considered for this role: AZ, ID, NM, NV, OR, TX, UT, WY

*** Prefer Veteran and Military Families ***

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:

o 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

Preferred:

o Bachelor's degree in Business, Health Care Administration, Data Analysis, or related field

o Lead role over a process or team

o Experience in interpreting policies, monitoring compliance, and developing processes

Key Responsibilities

o 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.

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.

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:

• Generous paid time off
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Medical, Dental and Vision Coverage
• 401(k) Retirement Savings Plan (with matching)
• Paid volunteer time

TriWest Healthcare Alliance is an equal employment opportunity employer. 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.