This position can be hired at the Senior Level P3 or P4 level. This position can be worked from a remote location, depending on state.
The primary focus of this position is to understand TRICARE regulations/policies to reduce claim-related errors and other areas of operational risk. This position will effectively assess processes, identify opportunities for improvement, quantify impact and translate customer needs into efficient, effective and streamlined processes within our business operations.
Individual will review and interpret data within complex claims systems to determine accuracy and compliance with contractual obligations. Participate in management reviews, including presenting and communicating analysis results to partners and customers, summarizing conclusions, and recommending a course of action. Act as a mentor to current Military Veteran Health (MVH) Process Analysts (PA) to enhance their knowledge of industry practices.
In this role you will:
P4-Senior Level: Work as a Tricare Subject Matter Expert and assist PA/Operational Business and System Analyst teams and Contract Management (Program Performance) with interpretation of contract manuals.
P3-Senior level: Grow into a Tricare Subject Matter Expert.
Effectively assess processes, identify opportunities for improvement, quantify impact and translate customer needs into efficient, effective and streamlined processes within our business operations.
Collaborates with cross functional groups to develop and implement system updates, ensuring continued improvement in the synchronization of systems, people, and processes.
Analyze and interpret claims data ensuring claims processing system is designed to accurately adjudicate claims consistent with healthcare coverage, reimbursement methodologies, and contractual requirements.
Actively collaborate with management and staff to ensure that industry best practices are followed and continually seek efficient and innovative processes, technologies and approaches to optimize use of resources and enhance operations.
Identify, prioritize and facilitate claims improvement projects.
Facilitate workgroups to identify ways to increase quality and efficiency and operational processes.
This role could be a good fit if you:
Possess strong communication skills.
Are analytical and love to dig into data.
Have strong experience researching policy regulations.
Have the ability identify deficiencies and help create process solutions.
Possess extensive experience with TRICARE regulations and operational standards.
You’ll benefit from this experience by:
Working in an environment that serves our Nation’s military, veterans, Guard and Reserves along with their families.
Serving as a subject matter expert in a team lead capacity.
Play a significant role with exploration, evaluation and design of in-house or purchased technology solutions for current and future business needs.
Having limitless opportunities for growth within the organization.
Having remote work options.
You need to have:
U.S. citizenship is required for this position due to Department of Defense restrictions.
Bachelor’s degree or equivalent work experience.
P4 Senior Level: 2 or more years of related work experience
P3 Senior Level: 1 or more years of related work experience
We also prefer:
P4 Level: 10 or more years of progressive experience in a healthcare claims processing environment that includes evaluating claims issues and trends to modify processes, workflows, and strategies AND 6 or more years of experience working on direct or indirect TRICARE contracts.
P3 Level: 8 or more years of progressive experience in a healthcare claims processing environment that includes evaluating claims issues and trends to modify processes, workflows, and strategies AND 4 or more years of experience working on direct or indirect TRICARE contracts.
Experience with government contracting, billing, interpretation of federal policies and manuals.
Lean six sigma background.
Compensation and Benefits
Eligible for annual Performance Bonus Program
401(k) with dollar-per-dollar match up to 6% of salary
Competitive paid time off
Health and dental insurance start DAY 1
Vision insurance
Flexible spending, dependent care, and health savings accounts
Short- and long-term disability, group life insurance
Dress for your day
Innovative professional and cognitive development programs
Who We Are
WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.
Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government’s Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.
Our purpose is to make healthcare easier for those we serve. Click Here
Our values – Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate – are the core of who we are and how we conduct business every day.
Health Insurance
WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.
WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.
WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we’ve served Medicare beneficiaries and their health care providers since 1966.
Arise Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
