Military & Veteran Health Payment Operations SME
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.