Claims Specialist - USFHP

Providence; Renton (WA); On-site; USD 60,000 - 75,000; Full time

Job summary

Providence is seeking a Claims Specialist to review, process, and adjudicate TRICARE medical claims in compliance with regulations and internal policies.

The role involves investigating discrepancies, addressing provider and beneficiary inquiries, and maintaining high-quality turnaround times in a healthcare reimbursement environment.

Qualifications

• H.S. Diploma or GED, or equivalent experience in Health Care Business Administration.
• 2 years in Managed Care operations.
• 1 yearclaims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.
• Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).

Responsibilities

• Review, process, and adjudicate TRICARE medical claims accurately and in accordance with regulations.
• Investigate claim discrepancies and respond to provider and beneficiary inquiries.
• Ensure compliance with healthcare reimbursement guidelines and maintain high standards for quality and turnaround times.

Skills

Managed Care operations

Claims processing

Specialty claim processing

Education

High School Diploma or GED

Tools

IDX healthcare software

Managed care information systems

Job description

The Claims Specialist is responsible for reviewing, processing, and adjudicating TRICARE medical claims accurately and in accordance with TRICARE regulations, contract requirements, and company policies. This role investigates claim discrepancies, resolves provider and beneficiary inquiries, ensures compliance with healthcare reimbursement guidelines, and maintains high standards for quality and turnaround times.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

• H.S. Diploma or GED, or equivalent experience in Health Care Business Administration.


• 2 years in Managed Care operations.


• 1 yearclaims processing experience, in a TPA, MSO, HMO, PHO or large group practice setting.


• Experience with areas of specialty claim processing (COB, Adjustments, Point of Service, Home Health and Encounters).


• Information systems supporting the administration of managed care products.

Preferred Qualifications:

• IDX healthcare software application.


• CHAMPUS, Medicare and/or Medicaid benefits/programs.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.