Claims Escalation Rep

Profile We offer remote work opportunities (AK, AR, AZ, CA, *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 reputed company 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 reputed company As part of the claims escalation team, provides training, reputed company and daily direction to the Claim Customer Service Representatives. Supports team by researching claims data, claim system, and authorizations to resolve provider claims questions. Interacts with reputed company entities and internal departments to resolve claims inquiries. Utilizes multiple software applications, applies business rules, and knowledge of provider or authorizations to resolve provider claims questions. Works under timelines while meeting accuracy and production goals. Education & Experience Required: High School diploma or G.E.D. One year experience working in a reputed company center Proficient with reputed company reputed company, Word and reputed company Strong Knowledge of medical terminology 2 years claims reputed company, billing experience or demonstrated reputed company as a TriWest Claims Customer Service Representative Strong written and verbal communication skills Preferred Associates degree in reputed company or reputed company field Key Responsibilities Reviews, analyzes and directs reputed company of reputed company claims issues. Interfaces with Claims and CCOPs leaders, CSRs, other internal departments, VA and vendors. Serves as a Subject Matter Expert to Claims Customer Service Representatives and other internal departments. Investigates recurring problems, identifying process improvements and reporting findings to leadership. Tracks daily questions and reputed company trends. Documents reputed company communications involving staff, Veteran, and provider contacts. Reviews large amounts of reputed company information from multiple sources, including validating appropriate data on claim. Collaborates with Claims sub-contractor to build or update authorization and provider records. Participates in training documentation creation and updates. Manages multiple task lists in accordance reputed company directed timelines. Maintains updated knowledge of software applications, Claims trends, and Claim CSRs procedures and processes. Complies with HIPAA regulations to protect reputed company of health information. Consistently meets department productivity and performance metrics. Manages and prioritizes daily workflow queues to ensure timeliness standards are met. Identifies and reports any potential reputed company or fraud issues to management. Practices reputed company and concise communication in writing and by phone. Performs other duties as assigned. Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: reputed company foster actions required for desired business reputed company through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under reputed company or negative circumstances; Adapt to different styles; Listen critically; Collaborate. Computer Literacy: Ability to function in a multi-system reputed company environment using Word, reputed company, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a reputed company of situations and individuals while maintaining a reputed company of purpose and mature problem-solving approach is required. Independent Thinking / Self-Initiative: Critical thinkers with ability to reputed company on things which matter most to achieving reputed company; Commitment to task to produce reputed company without direction and to reputed company necessary resources. Information Management: Ability to manage large amounts of reputed company information easily, communicate reputed company, and draw reputed company conclusions. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining reputed company and control of workflow. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements reputed company a high volume, high stress environment. Organizational Skills: Ability to organize people or tasks, reputed company to priorities, learn systems, reputed company time constraints and with available resources; Detail-oriented. Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with reputed company judgment; Has a realistic understanding of relevant issues. Team-Building / Team Player: Influence the actions and opinions of others in a reputed company direction and build group