We offer remote work opportunities (AK, AR, AZ, 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

The Government Request for Information (RFI) Analyst reviews incoming requests for information and ad hoc reporting requests from government customers, priority inquiries, and escalations associated with TRICARE programs. The Analyst researches and compiles facts associated with each inquiry; refers issues to appropriate subject matter experts and operations staff for action, response, or resolution; tracks ongoing research, resolution, and refinement of responses received; and uses knowledge of healthcare systems and the TRICARE program to develop written responses (when required) to address government RFIs and other priority inquiries. The Analyst confirms closure of issues and education or resolution with the requestor; follows up to ensure that systemic issues, processing errors, and staff, provider office, or program user education gaps are addressed; and interfaces both orally and in writing with government staff, other stakeholders, provider office staff, and internal TriWest staff.

This position works under the direction of the Manager, Government RFI to support response to government RFIs, priority inquiries, and ad hoc reporting requests across TriWest's TRICARE contract. Quality and timeliness of the Analyst's research and draft responses directly affect TriWest's ability to meet contract performance standards and maintain credibility with government customers, including the Defense Health Agency and Congressional offices. Work involves complex healthcare and regulatory research across multiple TriWest systems and functional areas. The Analyst must interpret TRICARE contract requirements, healthcare claims and authorization concepts, and clinical terminology to construct accurate responses for government audiences. The role operates within the TRICARE contract framework, HIPAA, the Privacy Act, and DoD information handling requirements.

Education & Experience

Required:

• Bachelor's degree in public administration, healthcare, communications, business management, or equivalent experience
• U.S. Citizen
• Must be able to receive a favorable interim and final Department of Defense (DoD) background investigation
• Minimum of 2-4 years of demonstrated expertise in healthcare operations function such as provider services, claims, clinical operations, or customer service
• Demonstrated ability to manage multiple requests simultaneously under tight deadlines
• Proven experience investigating and/or responding to escalated issues or complaints
• Demonstrated strong verbal and written communication skills
• Strong working knowledge of MS Word, Excel, and Outlook

Preferred:

• Experience working with or for TRICARE, Defense Health Agency, or other federal health care programs (this experience is a key differentiator for the role and supports the Analyst's ability to draft substantive responses for review by subject matter experts rather than redirecting drafting work to SMEs)
• Solid understanding of the Health Insurance Portability and Accountability Act (HIPAA), related privacy laws, and security measures (physical storage, open discussions, and electronic transmissions) for safeguarding Protected Health Information (PHI) and Personally Identifiable Information (PII)
• Experience working with or for Government agencies, Congressional offices, and/or the Defense Health Agency Health Care System
• Military experience (Veteran or retiree)

Key Responsibilities

• Support the Manager, Government RFI with the workflow processes relating to the workload received by the department
• Assist in the review of draft government correspondence before forwarding it to the Director, Request for Info (RFI), ePMO
• Assist in the crafting and review of draft responses to RFIs, priority inquiries, and government escalations
• Monitor progress against process timeframes and due dates to meet or exceed production metrics and contract performance standards
• Represent the Manager, Government RFI and the department in meetings (at the Manager's discretion)
• Review incoming requests for information, priority inquiries, and ad hoc reporting requests to determine the most appropriate and effective course of action
• Conduct thorough research and analysis of targeted issues by accessing multiple TriWest online systems and interfacing with TriWest staff in all functional areas regarding the services provided under TriWest's TRICARE contract
• Coordinate and communicate with various TriWest departments, subcontractors, field operational offices, and TRICARE stakeholders to obtain information required for substantive, quality responses to RFIs and priority inquiries; review departmental responses to ensure they appropriately address the concerns expressed in the inquiry

• Help prepare written responses to inquiries and coordinate all input into the planned response prior to managerial review
• Document communications with government staff, family members or other authorized representatives, provider office staff members, and TRICARE stakeholders
• Create and maintain records and files on RFI and priority inquiry casework; track all casework referred to TriWest departments or subcontractors to ensure documented outcomes for timely resolution; prepare and file casework
• Maintain logs and other tracking tools to assist department leadership with reporting and decision-making requirements
• Identify and report potential fraud or patient quality issues to the appropriate department
• Perform other duties as assigned
• Regular and reliable attendance is required

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapts to different styles; listens critically; collaborates. Recurring professional written and oral communication with internal staff (Manager, Director, TriWest subject matter experts across claims, clinical operations, customer service, and provider services; subcontractor staff; field operational offices) and external stakeholders (DHA, Congressional offices, TRICARE stakeholders, provider office staff, and authorized representatives).

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, the TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and a mature problem-solving approach is required.

Creativity / Innovation: Ability to develop unique and novel solutions to problems; views 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 the ability to focus on what matters most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Receives general supervision from the Manager, Government RFI; operates with limited day-to-day oversight on routine RFI casework, exercising judgment within established department procedures.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Organizational Skills: Ability to organize people and tasks, adjust to priorities, and 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; ability to maintain a realistic understanding of relevant issues and a willingness to discuss specific RFI cases with department management to ensure all resolution options have been considered. Routine matters are addressed using established guidelines; novel or escalated matters are referred to the Manager for direction.

Technical Skills: Working knowledge of the Defense Health Agency Health Care System and related programs that TriWest is contracted to administer for the DHA. Working knowledge of the DHN Regions TriWest is contracted to administer; familiarity with Privacy Act and HIPAA requirements that apply to all government inquiry and priority inquiry scenarios. Follows TriWest department procedures, response templates, and workflow standards established by the Manager, Government RFI; works within TRICARE contract performance standards, DHA reporting requirements, HIPAA Privacy and Security Rules, the Privacy Act, and DoD information handling requirements.

Working Conditions

Working Conditions:

• Availability to work non-regular hours as necessary
• Works within a standard office environment with minimal travel required
• 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
• 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

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $80, 000 - $85, 000 per year.

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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.