1 month ago
Job Description
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).
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Working under the direction of the Director of Customer Care & Community Relations, this position oversees and manages the company's responsibility under the VA Choice and Patient-Centered Community Care Programs to receive, manage, and resolve grievances and complaints concerning the provisions of services required under the contract. The individual will assist the Director as well as have responsibility for oversight of the Complaints and Grievance processes used to resolve customer concerns. The role will involve the creation of development plans and performance appraisals for personnel hired to support the Complaints and Grievance program, as well as the interviewing and hiring of open positions for such support within the department (following approval by the Director). The Manager must have a complete understanding of the VA Choice and PCCC programs with particular focus on TriWest's roles and responsibilities in support of VA; including the internal procedures and operations of the company. The incumbent must possess excellent oral and written communication skills and be able to work well with people, including professional and non-professional internal and external staff, Veterans, Congressional offices, providers, and subcontractors.
Education & Experience
Required:
o Bachelor's (BA/BS) Degree or equivalent work experience.
o Three to five (3-5) years of supervisory/managerial experience, or any combination of education and experience that provides an equivalent background.
o Experience with or knowledge of the VA Healthcare System, the VA Choice and PCCC programs, claims processing, insurance, or managed care.
o Experience in correspondence processing
Key Responsibilities
o Oversee daily processes required to respond to complaints and grievances, including the review and dispersal of correspondence, casework processing, the review and approval of outgoing correspondence.
o With direct oversight from the Director of Customer Care & Community Relations, develops, organizes, and implements the Complaints and Grievance communications with internal departments and oversees the preparation of the reporting required to VA in response to a Complaint or Grievance.
o Responsible for meeting TriWest's reporting requirements to VA on this workload, as well as other internal reports (as required) and meeting contractual and internal processing requirements for this workload.
o Work with the Vice President for Operations & Medical Management and other TriWest operations staff as required to ensure proper response to any and all Complaints and Grievances.
o Demonstrates effective written and verbal communication skills.
o Demonstrates creativity, flexibility and critical thinking skills.
o Demonstrates positive customer relations skills in dealing with Veterans, providers and other government entities or interested parties.
o Interfaces with all levels of TriWest employees in a knowledgeable manner and maintains professional working relationships.
o Perform other duties as assigned.
o Regular and reliable attendance is required
Competencies
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
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
o Availability to work non-standard hours
o Works within a standard office environment, with moderate travel
o Extensive computer work with long periods of sitting
o Department of Defense security clearance required
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.
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:
*Annual base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $83,000 - $92,000 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.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Working under the direction of the Director of Customer Care & Community Relations, this position oversees and manages the company's responsibility under the VA Choice and Patient-Centered Community Care Programs to receive, manage, and resolve grievances and complaints concerning the provisions of services required under the contract. The individual will assist the Director as well as have responsibility for oversight of the Complaints and Grievance processes used to resolve customer concerns. The role will involve the creation of development plans and performance appraisals for personnel hired to support the Complaints and Grievance program, as well as the interviewing and hiring of open positions for such support within the department (following approval by the Director). The Manager must have a complete understanding of the VA Choice and PCCC programs with particular focus on TriWest's roles and responsibilities in support of VA; including the internal procedures and operations of the company. The incumbent must possess excellent oral and written communication skills and be able to work well with people, including professional and non-professional internal and external staff, Veterans, Congressional offices, providers, and subcontractors.
Education & Experience
Required:
o Bachelor's (BA/BS) Degree or equivalent work experience.
o Three to five (3-5) years of supervisory/managerial experience, or any combination of education and experience that provides an equivalent background.
o Experience with or knowledge of the VA Healthcare System, the VA Choice and PCCC programs, claims processing, insurance, or managed care.
o Experience in correspondence processing
Key Responsibilities
o Oversee daily processes required to respond to complaints and grievances, including the review and dispersal of correspondence, casework processing, the review and approval of outgoing correspondence.
o With direct oversight from the Director of Customer Care & Community Relations, develops, organizes, and implements the Complaints and Grievance communications with internal departments and oversees the preparation of the reporting required to VA in response to a Complaint or Grievance.
o Responsible for meeting TriWest's reporting requirements to VA on this workload, as well as other internal reports (as required) and meeting contractual and internal processing requirements for this workload.
o Work with the Vice President for Operations & Medical Management and other TriWest operations staff as required to ensure proper response to any and all Complaints and Grievances.
o Demonstrates effective written and verbal communication skills.
o Demonstrates creativity, flexibility and critical thinking skills.
o Demonstrates positive customer relations skills in dealing with Veterans, providers and other government entities or interested parties.
o Interfaces with all levels of TriWest employees in a knowledgeable manner and maintains professional working relationships.
o Perform other duties as assigned.
o Regular and reliable attendance is required
Competencies
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
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
o Availability to work non-standard hours
o Works within a standard office environment, with moderate travel
o Extensive computer work with long periods of sitting
o Department of Defense security clearance required
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.
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, Illinois, Minnesota, Washington D.C. and Washington State residents: $83,000 - $92,000 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.
About TriWest Healthcare
Learn More About TriWest Healthcare
