TriWest Healthcare Alliance · 1 day ago
Claims Reviewer
United States
Full-time
Remote
Entry, Mid Level
$54K/yr - $57K/yr
2+ years expTriWest Healthcare Alliance is dedicated to serving those who have served in the military. They are seeking a Claims Reviewer to conduct retrospective reviews of medical and behavioral health claims, ensuring compliance with government contract requirements and providing necessary information to various stakeholders.
Health Care
No H1B
Security Clearance RequiredU.S. Citizen Only
Responsibilities
Validates claim outcomes for accuracy and routes for adjustment, as necessary
Conducts medical claims review using current claims processing guidelines and established clinical and program criteria
Validates claims submission details against systems data
Adheres to all desktop procedures for assigned function
Identifies and appropriately communicates processing discrepancies or trends
Reviews claim data for process improvements
Communicates effectively and professionally with internal and external partners
Consistently meets or exceeds individual performance expectations
Identifies and reports potential quality or fraud issues to per established procedures
Performs other duties as assigned
Regular and reliable attendance is required
Qualification
Required
High School Diploma or GED
U.S. Citizenship
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
2 years of claims review experience
Knowledgeable in medical, institutional, and behavioral health claims processes
Demonstrated ability to communicate effectively, both verbally and in writing
Experience using MS Word, Excel, and Office
Preferred
Government claims experience
Claims coding certification or equivalent experience
Intermediate proficiency with MS Office suite
Benefits
Medical, Dental and Vision Coverage
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
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2025-01-30Debt Financing
Leadership Team
Mark E. Babbitt
Senior Advisor to President & CEO
Joseph Oddo
Vice President and Chief Information Officer
Recent News
EIN Presswire
2025-07-22
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