Claims Specialist - USFHP

Providence • Renton, WA

16d

About The Position

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.

Requirements

• 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.

Nice To Haves

• IDX healthcare software application.
• CHAMPUS, Medicare and/or Medicaid benefits/programs.

Responsibilities

• Reviewing, processing, and adjudicating TRICARE medical claims accurately and in accordance with TRICARE regulations, contract requirements, and company policies.
• Investigating claim discrepancies.
• Resolving provider and beneficiary inquiries.
• Ensuring compliance with healthcare reimbursement guidelines.
• Maintaining high standards for quality and turnaround times.

Benefits

• Best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED