TriWest Healthcare Alliance

Design and develop web applications, APIs, and interfaces, and support system integration and troubleshooting. | Requires 5+ years in object-oriented .NET development, experience with web services and SQL, and front-end skills in JavaScript frameworks. | Profile 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 Full Stack Application Developer Sr will work closely with our technology team and business partners to help find new solutions in meeting ongoing business needs. The ideal candidate will design and write high quality .Net code, web applications, and web services while working in a fast pace agile environment collaborating with both internal and 3rd party technologists. Responsibilities include building applications from scratch, optimizing existing code, and significant contributions to identify new development tools and team coding standards. This role will provide advanced technology and functional application support to define and streamline business processes. Education & Experience Required: • Bachelor’s degree in Information Technology, Computer Engineering, or similar field or equivalent work experience • 5+ years of Object Oriented application experience in .NET development (C#, ASP.NET, web API) • 3+ years of experience integrating applications using SOA/web services. • 3+ years of experience with SQL on Oracle or MSSQL platforms • 3+ years of experience in web based front end development (JavaScript, JQuery, Bootstrap, Angular JS) • Experience communicating with both technical and Business audiences. Preferred • Experience working in a call center environment or in a healthcare environment. • Experience with web libraries such as Angular.js 1.5+ or React • Strong written and verbal communication skills. • Knowledge of HIPAA EDI transactions and datasets • Technical experience working with healthcare systems or in a government contact systems environment • Expertise with MVC, design patterns, and modern architectural trends • Familiarity with Team Foundation Server and build automation tools • Experience with service-oriented architecture (SOA), Web Services, and REST protocols • Experience with software testing (Functional, Performance, and Unit Testing) Key Responsibilities • Assists with the planning, coordination, and direction of application activities related to current and proposed design. • Help design UI and workflows based on business needs. • Recommends changes in procedure in order to promote better utilization of application functionality. • Investigates and recommends new tools and applications in support of business needs. • Provides support and expertise to functional users to assist with system problems impacting the accuracy or completeness of their work. • Coordinates with client departments to maintain communications support to allow the applications to function properly and efficiently. • Participates in regularly-scheduled project reviews and project statuses with client departments. • Serves as a technical and functional resource to entry level developers. • Obtains and shares knowledge of how various application modules inter-link and affect one another. • Analyzes, develops and supports multiple system interfaces and data integration. • Evaluates and tests vendor-supplied software packages. • Determines compatibility with existing systems. • Maintains user manuals, system design documents, and program documentation. • Performs on-call support functions. • Performs other duties as assigned. • Regular and reliable attendance is required. • Work in a team environment using Agile Project Management (Scrum) and Test Driven Development • Participate in all Scrum activities such as creating user stories, sprint planning, and sprint retrospectives Competencies Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate. 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. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow 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: Advanced knowledge and expertise in applications programming methodologies and disciplines; Expert knowledge in system analysis and business problem-solving; Leadership ability; Collaboration skills; Exposure to Object Oriented Programming Principles and Web Development concepts. Working Conditions Working Conditions • Works in a standard office environment, with weekend or nighttime work to implement changes o Extensive computer work with prolonged 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. 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 $125,000 - $139,000 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.

Provide training and daily direction to claims customer service representatives, resolve complex claims issues, collaborate with internal and external stakeholders, and ensure compliance with HIPAA and department productivity goals. | High school diploma or GED, 1 year call center experience, 2 years claims resolution or billing experience, proficiency with Microsoft Office, strong communication skills, and knowledge of medical terminology. | 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 As part of the claims escalation team, provides training, resolution and daily direction to the Claim Customer Service Representatives. Supports team by researching claims data, claim system, and authorizations to resolve provider claims questions. Interacts with outside entities and internal departments to resolve claims inquiries. Utilizes multiple software applications, applies business rules, and knowledge of provider or authorizations to resolve provider claims questions. Works under timelines while meeting accuracy and production goals. Education & Experience Required: • High School diploma or G.E.D. • One year experience working in a call center • Proficient with Microsoft Outlook, Word and Excel • Strong Knowledge of medical terminology • 2 years claims resolution, billing experience or demonstrated success as a TriWest Claims Customer Service Representative • Strong written and verbal communication skills Preferred • Associates degree in healthcare or related field Key Responsibilities • Reviews, analyzes and directs resolution of complex claims issues. • Interfaces with Claims and CCOPs leaders, CSRs, other internal departments, VA and vendors. • Serves as a Subject Matter Expert to Claims Customer Service Representatives and other internal departments. • Investigates recurring problems, identifying process improvements and reporting findings to leadership. • Tracks daily questions and resolution trends. • Documents all communications involving staff, Veteran, and provider contacts. • Reviews large amounts of complex information from multiple sources, including validating appropriate data on claim. • Collaborates with Claims sub-contractor to build or update authorization and provider records. • Participates in training documentation creation and updates. • Manages multiple task lists in accordance within directed timelines. • Maintains updated knowledge of software applications, Claims trends, and Claim CSRs’ procedures and processes. • Complies with HIPAA regulations to protect privacy of health information. • Consistently meets department productivity and performance metrics. • Manages and prioritizes daily workflow queues to ensure timeliness standards are met. • Identifies and reports any potential quality or fraud issues to management. • Practices professional and concise communication in writing and by phone. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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. 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. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. 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: Knowledge of CCN policies, processes, and procedures, knowledge of call management methodology. Working Conditions Working Conditions • Ability to cover any work shift with no travel • Works within a standard office environment • Extensive computer work with prolonged sitting and wearing of headset • VA-approved security clearance may be 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: $47,000 - $60,000 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.

Manage clinical operations compliance with URAC and DoD standards, oversee policy development, lead accreditation efforts, and supervise clinical audit programs. | Must have RN or LCSW license, 5+ years in healthcare quality/compliance management, 5+ years managing staff and programs, US citizenship, and ability to pass DoD background check. | Profile This is a hybrid position, mostly remote, but onsite in Phoenix, AZ occasionally. 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 Manages Clinical Operations Regulatory Compliance, policy development, and program execution. This position reports to the VP Clinical Operations and coordinates with clinical operations leaders to assure URAC and T-5 Contract compliance. This position will have the responsibility to develop, implement and provide oversight of TriWest Clinical compliance program, ensuring adherence to all applicable federal, state and local regulations, as well as accreditation standards. This role focuses on maintaining the integrity of the clinical operations through robust policies, procedures, auditing and effective governance oversight. Education & Experience Required: • Current, unrestricted Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) license recognized as valid by the applicable state licensure board where the position is located • Bachelor's Degree in Nursing, Social Work, Health Care Administration or other health related field • U.S. Citizen • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation • 5 years’ experience quality, compliance or related field in healthcare • 5 years’ experience in management of staff and programs Preferred • URAC (Utilization Review Accreditation Commission) recognized Case Manager Certification Master's Degree in Nursing or related field • Previous experience leading and managing case management or utilization management Veterans Healthcare or TRICARE Program experience • Demonstrated experience in performing analysis of utilization and quality data and with policy development and technical writing Key Responsibilities • Provides leadership to ensure compliance with URAC standards. • Directs all aspects of URAC accreditation for relevant clinical programs. • Supervises accreditation coordinators and collaborates subject matter experts related to accreditation compliance. Organizes and coordinates workflows with immediate team and related teams. Provides direction, coaching, performance management and issues resolution to team. • Ensures ongoing compliance with all URAC standards, including continuous monitoring, gap analysis, implementation. • Ensures comprehensive documentation for URAC accreditation, including policies, procedures, training records, and evidence of compliance. • Provides oversight of Clinical Operations Policy and Procedure Development and management. • Develops, reviews, revises and maintains all clinical operations policies and procedures to ensure compliance with regulatory requirements, URAC and internal best practice. • Establishes a systematic process for policy review cycles, approvals, communication and version control. • Designs, implements, and manages a comprehensive clinical auditing program to assess adherence to policies, procedures, regulatory requirements, and URAC standards. • Conducts routine and ad hoc audits of clinical operations departments, provider credentialling, appeals and grievances related to clinical operations, and special oversight programs related to quality of care delivered in the network (e.g. prescription monitoring and TRICARE Quality Monitoring Contract or TQMC). • Provides oversight and coordination of the clinical audit programs and performs analyses to measure program impact and identify opportunities to improve the effectiveness of the program to meet performance targets. • Performs annual and ongoing evaluation of the Clinical programs to ensure adherence to URAC standards, TRICARE policy, contractual requirements, HIPAA privacy and nationally recognized practice. • Develops training programs, training documents, and flow diagrams to address targeted operational issues related to compliance and audit. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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, Excel, PowerPoint, Outlook, TriWest Intranet, the Internet, and department software applications. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. 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. Ability to plan, implement, and monitor program effectiveness and efficiency. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of TRICARE programs and benefits, URAC national best-practice standards; health care delivery; clinical quality assurance program metrics, utilization management, case management, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations. Working Conditions • Works non-regular hours, as required • Works hybrid, remotely and in office, with 10% travel • Extensive computer work with prolonged sitting • 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 • 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 $109,000 to $139,000 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.

Manage escalated customer service inquiries via chat, phone, and electronic messaging, provide subject matter expertise on TRICARE benefits, support leadership with data and training, and ensure customer satisfaction in a fast-paced environment. | High school diploma or GED, U.S. citizenship, call center or TriWest customer service experience, ability to pass DoD background check, and knowledge of customer service processes. | Profile • Must Reside in Alaska** Job Summary Manages escalated and complex scenarios through chats, telephonic interaction, and electronic messaging from Customer Service Representatives, internal TriWest departments, and Defense Health Agency personnel. Provides back-up phone and payment support during periods of high inbound call volume and/or high task inventory. Works in a detailed, multi-tasked and fast-paced production environment. Education & Experience Required: • High School diploma or G.E.D. • U.S. Citizen • Must be able to receive a favorable interim and final Department of Defense (DoD) background investigation • At least one year of TriWest customer service experience or previous call center team lead experience within the last 3 years Preferred • Health plan experience in a customer service setting • Associate’s degree or health care related certification Key Responsibilities • Assigned to the Navigator call queue, provides subject matter expertise (SME) by correctly answering telephonic, electronic and chat inquiries regarding operational processes and complex customer service inquiries. • Develops and maintains TRICARE benefit knowledge, processes and procedures. Attends and masters applicable training. • Handles escalated inquiries from staff and other departments ensuring a quick and accurate resolution to maintain internal and external customer satisfaction. • Connects with other department designated SMEs as needed to ensure first call resolution. • During times of excessive inbound call volumes and/or task inventory, takes inbound or makes outbound calls depending on call volume needs. • Takes direct inbound calls from specialized populations such as BEPP, BCAC, DCAO, MMSO, DHA to resolve caller concerns or questions. • Tracks and analyzes escalation patterns to identify common issues, knowledge gaps, or process inefficiencies, sharing findings with management to drive improvements in training, policies and workflows. • Partners with the Training, Knowledge Management, as well as other departments to resolve the identified knowledge gaps by supporting leaders with tools and information to resolve concerns. • Maintains updated knowledge of software applications, on-line systems, Customer Service Representative procedures and processes. • Assists Customer Service Representative leaders in tracking learning opportunities and Navigator Support Desk utilization. • Supports the leadership teams through data and program knowledge. Coaches to correct responses but does not performance coach/lead. • Documents all communications involving customer contacts. • Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialists, Military and Veteran’s Services (MVS), and DHA, other departments when requested. • Consistently contributes to the achievement of department productivity and performance metrics. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to unique 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. 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. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. 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: Knowledge of TriWest policies, processes, and procedures, knowledge of call management methodology. Working Conditions Working Conditions • Ability to cover any work shift with no travel • Works within a standard office or virtual environment • Extensive computer work with prolonged sitting and wearing of headset • 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. 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, Illinois, Minnesota, Washington D.C. and Washington State residents: $43,000 - $55,000 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.