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 Director, Claims Admin is responsible for claims subcontractor oversight and performance. This role is a strategic thinker and is an advocate for continuous improvement throughout the organization. This position leads and is accountable for multiple Claims Managers (or related invoicing), who are responsible for delivering business results in their respective areas. The Director, Claims Admin works collaboratively with the claims processing subcontractor, internal business partners, and the Government to improve processes, deploy changes, and resolve issues timely. This role is a key collaborator and stakeholder in regard to TriWest systems integrations, claims subcontractor configuration changes and requests, and Government program updates.

Education & Experience

Required:

• Bachelor's degree in Business Administration, Finance, or Health Care Administration or similar degree; OR equivalent experience • 7 years' of healthcare claims, audit, or billing experience • 5+ years of Supervisory experience • Intermediate proficiency with MS Office suite, with an emphasis on Excel • Experience with data management or statistical analysis • Knowledgeable of Medicare claims processing guidelines and payment rules • Experience performing claims-related research and analysis

Preferred:

• Experience with Government healthcare claims • Proficiency with SQL queries • Claims coding certification or equivalent experience • Experience with business process and design analysis

Key Responsibilities

• Oversight of TriWest claims subcontractor • Leads and participates in claims related improvement initiatives. Makes sound recommendations around claims system, configuration, workflow, and/or procedural changes • Leads or assists in the identification and resolution of key business or provider issues. Collaborates with internal TriWest departments, claims subcontractor, and the Government to resolve Veteran and Provider claims concerns timely and appropriately • Management of multiple claims functions and teams • Reviews trends and performs root cause, quantitative, and qualitative analysis to identify system or process improvements aimed at enhancing claims knowledge, efficiency, and accuracy. Presents information to various audiences and makes sound, data-driven recommendations • Collaborates in systems integration work between TriWest, claims processing subcontractor, and Government systems • Review Government change orders for impact to TriWest systems and claims outcomes, and provide feedback as necessary

• Responsible for the preparation, review, and documentation of TriWest and claims subcontractor changes to the subcontractor claims processing system. May assist in validating the accuracy of change-related testing and documentation • Evaluates and distills analyses conducted by other departments and/or outside consultants • 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 styles; listen critically; collaborate.

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

Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Research skills which include the interpretation of written policy, automated transactions and communication of the results of work items to appropriate management; ability to document trends and assimilate data; knowledge of UB04 and CMS 1500 claims billing criteria; ability to thoroughly research a transaction type from beginning to end. Knowledge of Systems, mainframe - oracle interfaces, visual basic and web systems. Knowledge with Microsoft Office Suite to include advanced Excel skills.

Working Conditions

Working Conditions:

• Favorable working conditions in a climate controlled office space • Some travel required • Availability to work non-regular hours as 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 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 $158,000 to $176,000 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.