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

Under the direction of the Director, Request for Info (RFI), ePMO, this position manages the response process for Requests for Information (RFI) submitted by government customers, including the Defense Health Agency (DHA), Congressional offices, and other federal stakeholders. The role involves close coordination and communication with TriWest leadership and internal staff on complex and high visibility beneficiary, Veteran, and TRICARE member cases. The Manager assists the Director with day-to-day operational oversight of the written RFI correspondence and ad hoc reporting request processes used to address and resolve high visibility case issues, working in close coordination with TriWest clinical, customer service, and operations staff.

This position is responsible for the day-to-day operations of TriWest's Government RFI function, with enterprise-level visibility. Decisions and responses produced by this role are submitted to government customers and influence TriWest's contract performance and reputation with the Defense Health Agency and Congressional offices. Errors or delays in RFI response can affect TRICARE contract performance metrics and TriWest's standing with federal stakeholders. Work is complex and high visibility, spanning multiple TriWest functions (clinical, claims, customer service, provider services), requiring interpretation of TRICARE contract requirements and DHA reporting standards, and coordination of input from subject matter experts across the enterprise to construct accurate, timely, and contractually compliant responses. The role operates in a regulated environment governed by HIPAA, the Privacy Act, and DoD information handling requirements. The Manager exercises judgment within established department processes and TRICARE contract performance standards, and escalates novel or high-risk matters to the Director.

Education & Experience

Required:

• High School diploma or GED
• U.S. Citizenship
• Must be able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation
• At least two years of progressively responsible experience in health care complex case coordination, including managing complex case programs
• At least two years of supervisory experience
• Experience in investigating and/or responding to escalated issues or complaints
• Experience working with VA and/or DoD health care programs (CCN/TRICARE)
• Excellent proven oral and written communication skills
• Strong working knowledge of MS Office

Preferred:

• Bachelor's (BA/BS) Degree in Business Administration, Healthcare, Social Work, or equivalent experience
• Experience in the health care industry
• 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)

Key Responsibilities

• Serve as the internal primary point of contact and manager for day-to-day operations of Requests for Information and Government ad hoc reporting requests.
• Manage identification of TRICARE inquiries for inclusion in priority response programs and escalation of select cases for high-touch engagement by other department staff.
• Manage intake of requests, clarification of requests, identification of subject matter experts, workload distribution, monitoring against deadlines, and trending of issues and risks.
• Collaborate with the Director, Request for Info (RFI), ePMO on escalations and mitigation of issues and risks.
• Serve as the first review for routine responses and collaborate with the Director on complex responses.
• Manage templates, department desk procedures, and workflows.
• Respond to complex RFIs and ad hoc report requests.
• Create policies and procedures, program reports, and development plans, and coordinate with Data Management staff on ongoing improvements to data analysis and reporting of RFI written correspondence and ad hoc reporting data.
• Hire and manage staff, including interviewing and selection following approval by the Director and senior TriWest leadership; onboard, develop, and conduct performance management.

• In collaboration with the Director, develop, organize, and implement strategic communications with internal leadership and across all internal departments.
• Manage the preparation of reporting required for TriWest leadership awareness.
• Work with TriWest administrative, operational, and clinical staff and leadership as required to ensure proper response to all RFI written correspondence cases and ad hoc reporting requests.
• Interface with all levels of TriWest employees in a knowledgeable manner and maintain professional working relationships.
• 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. Communicates tactfully and professionally with all levels of leadership in relation to the primary mission. Translates technical and clinical content into clear written communications appropriate for federal audiences. Recurring contact with internal staff (TriWest leadership; clinical, customer service, claims, provider services, and operations staff; Data Management; subject matter experts) and external stakeholders (DHA, Congressional offices, and other federal stakeholders).

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

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.

Leadership: Receives general supervision from the Director, Request for Info (RFI), ePMO, with broad objectives and significant latitude for independent action. Provides direct supervision to the Government RFI Analyst and any additional analyst staff assigned to the function, including hiring, performance management, coaching, workload assignment, and development. Successfully manages different styles of employees; provides clear direction and effective coaching. Sets standards for response quality, timeliness, and contract compliance, and holds the team accountable to those standards. Decisions affecting department strategy, staffing, or budget are made in collaboration with the Director.

Multi-Tasking / Time Management: Prioritizes and manages actions to meet changing deadlines and requirements within a high volume, high stress environment.

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: Solves problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues and identifies root causes of recurring response challenges. Within established frameworks, exercises judgment to develop department-level procedures, response templates, and workflow standards.

Team-Building / Team Player: Influences the actions and opinions of others in a positive direction and builds group commitment.

Technical Skills: Thorough understanding of healthcare claims processing; knowledge of the Defense Health Agency and/or VA Health Care System and TriWest's systems, policies, and procedures; grievance and health care correspondence processing; research and analysis skills; trend identification and documentation; editing skills. Applies and enforces established TriWest policies, 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-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
• 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 $112, 000 - $118, 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.