We offer far off paintings possibilities (AK, AR, AZ, CO, FL, hello, IA, identification, IL, KS, l. a., 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 protection agreement requires US citizenship and a favorably adjudicated DOD heritage research for this position.
Veterans, Reservists, Guardsmen and navy circle of relatives participants are advocated to apply!
activity summary
As part of the claims escalation group, affords training, resolution and every day course to the claim customer service Representatives. supports group by discovering claims information, declare gadget, and authorizations to resolve company claims questions. Interacts with outside entities and internal departments to resolve claims inquiries. makes use of a couple of software applications, applies enterprise policies, and know-how of provider or authorizations to solve issuer claims questions. Works below timelines at the same time as assembly accuracy and manufacturing goals.
schooling & enjoy
Required:
• high school diploma or G.E.D.
• one year revel in working in a name center
• talented with Microsoft Outlook, phrase and Excel
• sturdy know-how of scientific terminology
• 2 years claims decision, billing enjoy or confirmed success as a TriWest Claims customer support representative
• sturdy written and verbal communique talents
favored:
• buddies diploma in healthcare or related area
Key responsibilities
• opinions, analyzes and directs decision of complicated claims problems.
• Interfaces with Claims and CCOPs leaders, CSRs, other internal departments, VA and companies.
• Serves as a topic be counted expert to Claims customer support Representatives and different internal departments.
• Investigates routine problems, figuring out procedure upgrades and reporting findings to leadership.
• Tracks every day questions and backbone developments.
• documents all communications involving body of workers, Veteran, and issuer contacts.
• opinions massive amounts of complicated data from more than one assets, inclusive of validating suitable facts on declare.
• Collaborates with Claims sub-contractor to construct or replace authorization and provider data.
• Participates in education documentation creation and updates.
• Manages more than one task lists in accordance within directed timelines.
• continues updated understanding of software program applications, Claims developments, and declare CSRs’ techniques and approaches.
• Complies with HIPAA regulations to shield privacy of fitness information.
• continuously meets branch productivity and overall performance metrics.
• Manages and prioritizes each day workflow queues to make sure timeliness standards are met.
• Identifies and reports any capability first-class or fraud problems to control.
• Practices expert and concise communication in writing and through phone.
• performs different obligations as assigned.
• ordinary and reliable attendance is required.
