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).
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 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.

IT’S WHO WE ARE. IT’S WHAT WE DO.

Do you have a passion for serving those who served?

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.

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
• 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 tim