What are the responsibilities and job description for the TRICARE Grievance Specialist position at Triwest Healthcare?
We offer remote work opportunity in AZ.
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!
Must have U.S. Citizenship.
Job Summary
The TRICARE Grievance Specialist reviews incoming TRICARE grievances submitted by TRICARE-eligible beneficiaries and / or their designees; researches and compiles facts associated with the grievance; refers issues to appropriate subject matter experts and / or operations staff for appropriate action / response / resolution; tracks ongoing research, resolution and / or refinement of responses received; develops written responses (when required) to address grievances and / or confirms closure of issue and education / resolution with the Beneficiary; follows-up to ensure that systemic issues, processing errors and staff, provider office representative or program user education gaps are addressed; interfaces both orally and in writing with DHA staff and other DHA stakeholders, TRICARE beneficiaries and their family members or other authorized representatives, provider office staff and internal TriWest staff.
Education & Experience
Required :
- H.S. Diploma or GED
- U.S. Citizenship
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
- Experience in investigating and / or responding to complaints
- Strong verbal and written communication skills
- Strong working knowledge of MS Word, Excel and Outlook
Preferred :
Key Responsibilities
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.
Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
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 thinkers 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.
Information Management : Ability to manage large amounts of complex information easily, communicate clearly and draw sound conclusions.
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; ability to maintain a realistic understanding of relevant issues and a willingness to discuss specific complaint / grievance cases with department management to ensure all resolution options have been considered.
Technical Skills : Working knowledge of the TRICARE program and related programs that TriWest is contracted to administer for DOD / DHA. Familiarity with Privacy Act and HIPAA requirements that apply to all customer grievance and routine correspondence scenarios.
Working Conditions
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 :
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.
