TRICARE Claims Specialist — Hybrid

Pacific Medical Centers; Renton (WA); Hybrid; USD 30,307 - 45,460; Full time

Job summary

Pacific Medical Centers is seeking a Claims Specialist to review, process, and adjudicate TRICARE medical claims in our Renton area. You will investigate discrepancies, respond to provider and beneficiary inquiries, and ensure compliance with reimbursement guidelines in a fast-paced environment.

Join our team in a cross-functional, patient-focused culture that emphasizes accuracy, timely processing, and high-quality outcomes.

Qualifications

• High school diploma or GED, or equivalent health care admin experience.
• 2 years in managed care operations.
• 1 year claims processing experience in a TPA, MSO, HMO, PHO or large group practice.
• Experience with COB, Adjustments, Point of Service, Home Health and Encounters.

Responsibilities

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

Skills

HS Diploma/ GED experience

Managed Care operations

Claims processing experience

Specialty claims processing

Information systems knowledge

Education

HS Diploma or GED; Health Care Admin

Tools

IDX healthcare software

Job description

Pacific Medical Centers is seeking a Claims Specialist to review, process, and adjudicate TRICARE medical claims in our Renton area. You will investigate discrepancies, respond to provider and beneficiary inquiries, and ensure compliance with reimbursement guidelines in a fast-paced environment.

Join our team in a cross-functional, patient-focused culture that emphasizes accuracy, timely processing, and high-quality outcomes.