Great place to work. Good benefits, opportunity to learn new job responsibilities adn room to grow
Pros: benefits, pay, customer satisfactions, working independently, acknowledgment of good work or ideas submitted
Cons: cases that were returned for recoupment, training of others who would not attend in class training sessions, dissatisfied beneficiaries
At TriWest as a fraud specialist, a typical day of work was reviewing appeals that came in via hotline, written, or email to determine if complaint was a true fraudulent issue or a claims billing/processing issue. Wrote summaries and gathered information and evidence to submit a fraud case to TRICARE for prosecution. Management was helpful, but most days were spent working independently. The hardest part were the dissatisfied beneficiaries that had to be forwarded to another department as their issue was not fraud related. the most enjoyable was the research of claims and determination of a fraud issue that resulted in meeting the dollar threshold to begin a fraud cases.