Claims Clerk

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).

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Provides clerical support for the Claims department, including receipt and processing of daily incoming mail. Performs photocopying and pulling claims and Explanations of Benefits (EOBs) off the on-line system using Filenet and Emdeon software. Annotates items in claims software systems. Maintains control of incoming faxes, including appropriate logging of receipt. Maintains files for Administrative Checks.

Education & Experience

Required:

• High School degree or G.E.D.
• 4 years' clerical experience, with business office experience
• Good written and verbal communication skills
• Experience with Word and Excel
  
  

Preferred

• Experience in the Healthcare Industry
  
  

Key Responsibilities

• Opens and sorts incoming Claims mail.
• Pulls documents off the on-line system, including claims files, correspondence, and appeals for audit purposes to assist Claims Reviewer with regular audits.
• Produces form letters to Veterans and providers.
• Interfaces with Claims Reviewers to provide support with their administrative needs.
• Coordinates records with other TriWest departments to assist with specialized claims audits as requested.
• Pulls claims documentation off the system for the Legal department as required.
• Supports department with other functions, including maintain the Administrative Check files.
• Supports the Collections unit with logging and controlling of collections cases.
• Performs other duties as assigned, including copying, filing, and other clerical support.
• Regular and reliable attendance is required.
  
  

Competencies

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.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Technical Skills: Knowledge of claims documentation processes; experience working with on-line records; typing and key entry experience.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Working Conditions

Working Conditions

• Works within an office environment, with minimal travel
• Availability to cover any work shift
  
  

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
• 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
  
  

*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $35,717.76- $37,702.08 depending on experience*

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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. 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.