Job Summary

Provides training, coaching and direction to Enrollment Fees team members. Communicates with regions and other TriWest departments to resolve issues, including eligibility, enrollment, and split enrollment, complex fee-related enrollments, status changes, reinstatements, refunds, fees, split-enrollments, and dis-enrollments. Employees are promoted to EFS, Team Lead based on a business need of the department.

Education & Experience

Required:

• High School diploma or G.E.D.
• Health plan operations experience such as member enrollment, contact center and billing
• Prior experience as a team lead

Preferred:

• Associate's degree or equivalent
• 4 years' experience in an administrative or medical office experience
• 2+ years' billing experience

Key Responsibilities

• Provides direction to EFS' in the processing of enrollment fees. Works with EFS' to resolve problems.
• Forwards enrollment problems to appropriate-level EFS' to resolve as needed. Keeps more complex issues to research and solve.
• Oversees various fees related processes, reconciliations and ensures adherence to established controls.
• Supports the administration of allotments, EFTs and other automated payment methods.
• Collaborates with project manager, subcontractor and Director on testing efforts for each bill cycle.
• Distributes and redistributes work to EFS' based on work volume and skill level.
• Researches and processes more complex fee-related enrollments, status changes, reinstatements, refunds, fees, split-enrollments, and dis-enrollments.
• Problem solves and works on more complex reports.
• Communicates with other TriWest staff to resolve complex issues.
• Coordinates with Claims department to reprocess claims for reinstated beneficiaries.

• Responds to incoming calls/e-mails/correspondence/faxes and provides timely resolutions to issues.
• Informs stakeholders of Enrollment changes and follows and provides reminders as needed.
• Tracks and responds to enrollment-related correspondence from beneficiaries.
• Assists in reconciling payments received with billings.
• Maintain all documentation of any payments returned to Beneficiaries if unable to apply.
• Assists in the documentation of established policies and procedures.
• Defines and implements processes and best practices to ensure quality assurance. Prepares and maintains desk procedures on how to work error and production reports.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

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.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

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

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Thorough knowledge of TRICARE program, policies and procedures; proficient with Defense Enrollment Eligibility Reporting System; knowledge of Enrollment-related software applications.

Working Conditions

Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment, with minimal travel
• Department of Defense security clearance 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
• Generous 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

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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions 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.