Manager, Claims Admin (Finance)

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).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

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

Job Summary

The Manager, Claims Admin is a steward of ensuring a positive experience and outcome when a claim event occurs. This position manages and is accountable for claims (or related invoicing) teams who are responsible for delivering business results. The Manager, Claims Admin works collaboratively with the claims processing subcontractor, internal business partners, and the Government to evaluate and resolve issues in a comprehensive and timely manner. This role is expected to drive issue resolution and promote ongoing continuous improvement activities.

Education & Experience

Required:

• Bachelor's degree in Business, Healthcare Administration, or related work experience
• 5 years of healthcare claims, audit, billing (or related healthcare area) experience
• 3 years of Supervisory experience
• Experience performing claims-related research and analysis
• Intermediate proficiency with MS Office suite, with an emphasis on Excel
• Knowledgeable of claims processing and medical management systems

Preferred:

• Claims coding certification or equivalent experience
• Proficiency with SQL queries
• Working knowledge of one or more process improvement methodologies (Six Sigma, Kaizen, DMAIC, etc.)
• Supervisory or higher experience in a claims or related healthcare or insurance environment

Key Responsibilities

• Manage claims team(s) who are responsible for researching, resolving, and/or responding to claims-related inquiries, reconsideration requests, escalations, and/or invoicing issues.
• Assists with oversight of the claims processing subcontractor to ensure performance and other expectations are met.
• Evaluate and recommend process improvement and claims strategies.
• Provide reporting, analysis, and action plans to Claims Leadership.
• Conduct activities aimed at leader and staff development and growth.
• Partner with the claims processing subcontractor to research and resolve Claims and/or Customer Service issues.
• Performs claims-related research and data analysis to quickly address issues when they arise and to proactively identify improvement opportunities.
• Lead and/or participate in a variety of cross-functional meetings and projects.
• Collaborate with the claims processing subcontractor on system enhancement design and other improvement initiatives.
• Work with Field Liaisons and internal partners to resolve claims issues for Veterans and the Government.

• Recommends, reviews, and modifies policies and procedures within the department, as necessary.
• Assist in the system integration work between TriWest, claim processing subcontractor, and Government systems.
• Management of proactive and retroactive claims reviews performed on a continual basis, to ensure claims accuracy and to identify issues and/or improvement opportunities.
• Partner with Finance and VA on invoice reconciliation activities, as assigned.
• Facilitates claim recoupment efforts when necessary.
• Perform other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances. Adapt to different behavior and communication styles. Listen critically. Collaborate effectively.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Excel, Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Independent Thinking / Self-Initiative: Critical thinking skills and the ability to appropriately prioritize tasks which are key to achieving outcomes. Self-motivated and committed to finding necessary resources to produce outcomes without direction.

Technical Skills: Research skills, which includes the interpretation of written policy and automated transactions. Communication of results of work items to appropriate management. Ability to identify and document trends. Extensive knowledge of UB04 and CMS 1500 claims billing criteria. Knowledge of Microsoft Office Suite to include intermediate or above Excel skills.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes.

High Intensity Environment: Ability to function in a fast-paced environment with multiple projects occurring simultaneously; while maintaining focus and managing workflow.

Working Conditions

Working Conditions:

• Availability to work non-regular hours, as necessary
• Works within a standard office environment
• Travel, as necessary
• Security clearance, if required

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

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 $91,000 to $101,000 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.