Government Contracting, Information Technology, Cybersecurity, Cloud Services

Military & Veteran Health Payment Operations SME

RemoteRemoteFull TimePosted 5 days ago

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Required skills

healthcare claims
payment integrity
federal healthcare program
operational oversight
claims administration
payment administration
SOPs
process maps
business requirements
quality controls

Nice to have

government payer
health plan
reporting tools
workflow-management tools

Role summary

Tria Federal is seeking a Healthcare Claims & Payment Operations Specialist to support a federal healthcare program. This role involves operational oversight, analysis of claims and payment issues, quality assurance, and process improvement. Responsibilities include accurate processing of Primary Family Caregiver stipend payments, investigating discrepancies, and developing SOPs and quality controls. The ideal candidate has 7+ years of experience in healthcare claims operations, payer payment administration, or government healthcare programs, with demonstrated ability to analyze complex issues and lead improvements. Strong communication and stakeholder engagement skills are essential, along with proficiency in Microsoft Office.

Who we are:

Tria Federal delivers digital services and technology solutions that support the health and safety of veterans, service members and civilians. For two decades, federal agencies have relied on Tria companies to advance their critical missions and modernize their systems, so that they can uphold their commitment to the American people. Today, we are pushing the boundaries of possibility through partnerships and investments in artificial intelligence and emerging technologies, developing solutions for the biggest challenges that government will face tomorrow.

We are proud to employ and support military veterans who bring mission-first mindset, technical expertise, and leadership qualities that strengthen our work. Veterans, transitioning service members, and military spouses are strongly encouraged to apply.

Tria Federal is seeking a Healthcare Claims & Payment Operations Specialist to support healthcare claims administration, payment integrity, and Primary Family Caregiver stipend-payment operations within a federal healthcare program. This role will provide operational oversight, analyze complex claims and payment issues, support quality assurance activities, and identify opportunities to improve payment accuracy, efficiency, and compliance.

The ideal candidate brings extensive experience in healthcare claims operations, payer payment administration, or government healthcare programs, along with the ability to translate program requirements into effective operational processes, controls, and recommendations.

Responsibilities:

Primary Family Caregiver Stipend Payments:

Support accurate and timely processing of stipend payments for Primary Family Caregivers in accordance with approved eligibility information, payment instructions, effective dates, and program-specific calculation requirements.

Validate payment inputs, reconcile scheduled and completed payments, investigate discrepancies, and support authorized payment adjustments and corrections.

Coordinate with caregiver program personnel and financial operations teams to resolve missing, delayed, duplicate, or inaccurate payments while maintaining appropriate supporting documentation.

Develop and maintain monitoring and quality controls to assess payment timeliness, calculation accuracy, unresolved exceptions, and changes impacting payment processing.

Process Improvement, Documentation & Implementation:

Translate payment operations requirements into standard operating procedures (SOPs), process maps, business requirements, training materials, quality controls, and decision-support documentation.

Partner with technology teams to identify and define system enhancements, validate payment-related business rules, develop test scenarios, support user acceptance testing (UAT), and assess operational readiness.

Maintain issue logs, corrective-action plans, decision records, and performance dashboards while communicating operational risks and recommendations to Government leadership.

Ensure sensitive beneficiary, provider, clinical, and financial information is handled in accordance with approved security, privacy, and access procedures.

Education & Experience:

Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Nursing, Health Information Management, or a related discipline. Education substitutions must align with applicable contract requirements.

Seven or more years of relevant experience in healthcare claims operations, payer payment administration, claims quality assurance, payment integrity, or government healthcare program operations.

Demonstrated experience independently analyzing complex claims or payment issues, developing recommendations, and leading corrective actions or operational improvements.

Claims & Payment Expertise:

Hands-on experience across the healthcare claims lifecycle, including intake, validation, adjudication support, payment processing, reconciliation, denials or rejections, and dispute resolution.

Ability to distinguish between eligibility, authorization, clinical review, coverage, reimbursement, and payment-processing issues and engage appropriate stakeholders to resolve them.

Experience interpreting program requirements and translating them into operational procedures, review criteria, and documented business rules.

Experience evaluating payment accuracy, processing timeliness, backlogs, exceptions, and internal controls using operational and financial data.

Consulting & Delivery:

Experience supporting a federal healthcare program, government payer, health plan, or third-party administrator (TPA) environment.

Strong written communication and stakeholder engagement skills, including the ability to develop executive briefings, case summaries, SOPs, and corrective-action plans.

Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Teams, as well as comparable reporting and workflow-management tools.

Ability to meet applicable Government suitability, background investigation, and information-access requirements.

Why Tria?What defines the Tria brand is more than just our dedication to excellence in our craft; it’s our incredible team of dedicated, talented, and passionate people that make Tria so exceptional. As people powering possible, we are all partners in our team’s shared success.

As a company that cares about people, we seek to cultivate a culture in which all can thrive personally and professionally. We offer a top-tier benefits package to invest in your physical, mental, and financial health and wellness so that you can be your best self - at work and in life. At Tria, we are growth-minded, entrepreneurial in spirit, and committed to fostering a culture of inclusion and opportunity for all. Whatever your background, your role, your department, or stage in your professional journey, here you will have opportunities to learn new skills, seize new challenges, and advance your career as we grow.

California Consumer Privacy Act (CCPA)

We are committed to protecting your privacy. As part of our compliance with the California Consumer Privacy Act (CCPA), we want to inform you about how we collect, use, and protect your personal information during the job application process. For more details, please review https://www.oag.ca.gov/privacy/ccpa.

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