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).
Veteran, Military Spouse or Military Affiliated are encouraged to apply!

JOB SUMMARY

The CGS reviews incoming customer complaints/grievances, priority inquiries and VA escalations associated with the VA Patient-Centered Community Care (VAPC3) and Veterans Choice programs; researches and compiles facts associated with the inquiry or complaint/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 customer complaints/grievances and other priority inquiries and/or confirms closure of issue and education/resolution with Veteran; 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 VA Health Care System staff and other VA stakeholders, Veterans and their family members or other authorized representatives, provider office staff and internal TriWest staff.

IT’S WHO WE ARE. IT’S WHAT WE DO.

Do you have a passion for serving those who served?

KEY RESPONSIBILITIES

• Reviews incoming complaint/grievance submissions and priority inquiries to determine the most appropriate and effective course of action.
• Conducts 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 VAPC3 and VCP contract.
• Coordinates with and communicates with various TriWest departments, subcontractors, field operational offices VA stakeholders and Veterans to obtain information required for substantive/quality responses to complaint/grievance submissions and priority inquiries. Reviews departmental responses to complaint/grievance submissions and priority inquiries to ensure that responses appropriately address the concerns expressed in the inquiry by the Veteran.
• Helps prepare written responses to inquiries and coordinates all input into planned response prior to managerial review.
• Documents communications with Veterans, family members or other authorized representatives, provider office staff members and VA stakeholders.
• Creates and maintains records and files on individual complaints/grievances and priority inquiry casework. Tracks all casework referred to TriWest departments or subcontractors to ensure that all casework has documented outcomes for timely resolution. Prepares and files casework.
• Identifies and reports potential fraud or patient quality issues to the appropriate department.
• Perform other duties as assigned.
• Regular and reliable attendance is required.

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 tim