Profile
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Working under the direction of the Director of Complaints and Grievances, this position oversees and manages the company’s responsibility under the TRICARE program to receive, manage, and resolve grievances and routine correspondence concerning the provisions of services required under the TRICARE West Region contract. concerns.
Education & Experience
Required:
- Bachelor's (BA/BS) Degree or equivalent work experience.
- Three to five (3-5) years of supervisory/managerial experience, or any combination of education and experience that provides an equivalent background.
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation.
- Experience in managing workflow processing for response and resolution of correspondence for customers (or similar customer service resolution)
- Excellent written and verbal communication skills
Preferred
- Experience with or knowledge of the DOD (TRICARE) and/or VA Healthcare System, claims processing, health insurance, or managed care.
- Veteran, retired military and/or military spouse
- Knowledge of TriWest operations/systems
Key Responsibilities
- Oversee daily processes required to respond to grievances and routine correspondence, including the review and dispersal of correspondence, casework processing, the review and approval of outgoing correspondence.
- With direct oversight from the Director of Complaints and Grievances, develops, organizes, and implements Grievance and Routine Correspondence communications with internal departments and oversees the preparation of the reporting required to submit to DHA in response to a TRICARE grievance and/or routine correspondence.
- The manager will help build and maintain a strong knowledge base of information on the TRICARE program for the benefit of their subordinates, with particular focus on TriWest’s roles and responsibilities in support of DHA and TRICARE contractual obligations, including the internal procedures and operations of the company.
- The Manager will assign incoming workload to staff based on casework type, issue complexity and staff casework volume levels. They will maintain awareness of casework status and deadlines through workload tracking and assess the quality of proposed responses before distribution and closure of casework.
- The Manager will be responsible for addressing escalated issues from staff to the appropriate levels for awareness and resolution, and will work with management in other functional areas to address any identified problems with support receives from subject matter experts
- Responsible for supporting TriWest’s reporting requirements to DHA on this workload, as well as the auditing of grievance workload (per contractual requirements) and completion of other internal reports (as required) and meeting contractual and internal processing requirements for this workload.
- Works with TriWest management across the organization as required to ensure proper response to any and all Grievances and Routine Correspondence submitted to SMEs for a response.
- Supports the maintenance and creation of form letters, subject briefs and documentation for use by staff in responding to Grievances and Routine Correspondence.
- Creates development plans and performance appraisals for personnel hired to support the Grievance and Routine Correspondence workload, as well as the interviewing and hiring of open positions for such support within the department (following approval by the Director).
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- Demonstrates positive customer relations skills in dealing with internal/external staff, beneficiaries, providers and other government entities (DHA) or interested parties.
- Interfaces with all levels of TriWest employees in a knowledgeable manner and maintains professional working relationships.
- Perform other duties as assigned.
- Regular and reliable attendance is required
Competencies
Creativity / Innovation: Ability to develop unique and novel solutions to problems; view change as necessary.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Independent Thinking / Self-Initiative: Critical thinker with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.
Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Thorough understanding of healthcare claims processing, knowledge of VA Healthcare System and TriWest's systems, policies, and procedures, grievance / health care correspondence processing, research and analysis skills, trend identification and documentation, editing skills
Working Conditions
Working Conditions
- Availability to work non-standard hours
- Works within a standard office environment, with moderate travel
- Extensive computer work with long periods of sitting
Company Overview
Taking Care of Our Nation’s Heroes.
It’s Who We Are. It’s What We Do.
Do you have a passion for serving those who served?
Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!
Our job is to make sure that America’s heroes get connected to health care in the community.
At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Benefits
We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Generous paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $86,152.60- $110,083.88 depending on experience*
Equal Employment Opportunity
TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.
