TRICARE Claims Specialist — Hybrid Work

Providence Health Plan Group; Renton (WA); Hybrid; USD 2,968,728 - 4,619,092; Full time

Job summary

Pacific Medical Centers (PacMed) seeks a Claims Specialist to review, process, and adjudicate TRICARE medical claims with accuracy and adherence to TRICARE regulations and company policies.

The role involves investigating discrepancies, resolving provider and beneficiary inquiries, and ensuring compliance with reimbursement guidelines while maintaining high quality and timely turnaround times. Providence-affiliated network emphasizes patient-centered care and supportive benefits.

Qualifications

• H.S. Diploma or GED, or equivalent experience in Health Care Business Administration.
• 2 years in Managed Care operations.
• 1 year claims 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.

Responsibilities

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

Education

High school diploma or GED

Job description

Pacific Medical Centers (PacMed) seeks a Claims Specialist to review, process, and adjudicate TRICARE medical claims with accuracy and adherence to TRICARE regulations and company policies.

The role involves investigating discrepancies, resolving provider and beneficiary inquiries, and ensuring compliance with reimbursement guidelines while maintaining high quality and timely turnaround times. Providence-affiliated network emphasizes patient-centered care and supportive benefits.