Job Description:

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!

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, TX, UT, VA/DC, *WA, WI & WY only)

Job Summary

Serves as a subject matter expert and liaison on behalf of Claims Administration. This role requires regular collaboration with TriWest cross-functional teams, Corporate Communications, and the Claims Subcontractors to assure Government program requirements are being communicated accurately and adhered to by all parties. The Claims Content Specialist is responsible for gathering information, validating content, and assisting in the development of (internal and external facing) claims-related communications or procedures. This includes, but is not limited to: training materials & job aids, provider communications, provider education materials, provider handbook and forms, procedural and contract change communications, and internal talking points. This role will also work closely with the Corporate Training to ensure new hire and continuous training for Claims Admin and Claims Customer Service functions remains accurate and relevant. The Claims Content Specialist's main objectives are to ensure operational consistency and Government contract adherence, as it relates to Claims policy and procedure, across the enterprise.

Education & Experience

Required:

• Associate's degree in a relevant field (e.g., Business Administration, Technical Writing, etc.) or equivalent work experience
• 2 years of claims-related healthcare experience
• Excellent written communication and/or technical writing skills, with a strong attention to detail and demonstrated results
• Demonstrated ability to understand claims processes and translate them into well-structured communications or procedures

Preferred:

• Bachelor's degree in a relevant field (e.g., Business Administration, Technical Writing, etc.) or equivalent work experience
• Government claims experience

Key Responsibilities

• Collaborates with department leaders, subject matter experts, and other internal partners to gather information and thoroughly understand existing processes or requirements, as well as upcoming changes.
• Coordinates with Corporate Communications to follow established policies for the approvals of internal and external communications.
• Maintains a clear understanding of Government contracts, as they relate to Claims processing.
• Attends project and contract modification meetings to ensure thorough understanding of changes, processes, and timelines, so communication is executed efficiently.
• Drafts and revises claims content related to provider-facing reference materials, forms, letters, education, and change communications.
• Drafts and revises claims content related to enterprise operational processes, contract & procedural changes, training materials, job aids, bulletins, functional procedures, workflows, templates, and other internal communications.
• Develops content that is clear, concise, easily understood, and appropriately formatted for the intended audience(s).
• Effectively manages and resolves disputes about claims operational processes to assure accurate outcomes and prevent delays in timeline.

• Communicates claims operational process changes and critical updates to the necessary stakeholders, to include enterprise staff, organizational leaders, and external audiences.
• Works closely with organizational leaders and instructional designers to develop and update claims training curriculum for various audiences.
• Partners with Corporate Communications and Training to finalize materials and/or communications as appropriate.
• Completes assigned tasks within defined timelines and manages time efficiently.
• Monitors claims performance trends to identify content gaps in training materials and procedural documents.
• Possesses and maintains a working knowledge of assigned Government program(s).
• Collaborates closely with Management to achieve goals and performance standards.
• Performs other duties assigned.

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, Excel and PowerPoint, TriWest Intranet, the Internet, and department software applications.

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

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

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

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

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

Technical Skills: Working knowledge of claims systems and other operational software applications.

Working Conditions

Working Conditions:

• Works in a standard office environment
• Occasional travel may be required - less than 10% per year
• Extensive computer work with prolonged sitting

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

*Annual base salary for Colorado and Washington State residents: $55,000 - $62,000 depending on experience*

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.

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