TRICARE Claims Customer Support Representative

Overall Purpose of the Role

The Claims Customer Support Representative, based in San Antonio, Texas is the first point of contact for the client, providing a full range of operational support to those seeking access to the TRICARE Overseas Program (TOP). Responding to inbound calls or contact from our beneficiaries based around the world, either current or former members of the US military and their families, who want to access medical services. 
 

Key Responsibilities

• To assist beneficiaries and providers with claims enquiries and help resolve problem cases, either “one and one” or by referral to dedicated In Country and/or regional claim resources.
• Resolve claims issues on behalf of providers and beneficiaries, working with Intl.SOS teams and WPS to ensure timely and accurate resolution. 
• Answer all incoming calls promptly using the prescribed protocols and ensuring complete resolution.
• Make outbound calls to follow up with beneficiaries and providers on claims queries, when appropriate.
• To work with Intl.SOS teams and designated government points of contacts to ensure TRICARE claims processes and benefits rules are understood and communicated accurately to beneficiaries 
• Actively promote electronic claims submission and payment solutions and other self-servicing products.
• Demonstrating a professional, positive, caring, and empathetic approach when assisting callers.
• Maintains confidentiality of all beneficiary information. 
• Maintain specific quality and quantity standards.
• Adhere to company policies and procedures at all times. 
• Assist with the training of new staff by mentoring them during their training program upon request.
• Comply within established service recovery protocol. 
• Attends and participates in International SOS staff meetings and educational offerings.
• Carrying out any other reasonable duties as requested by the manager.

Required Qualifications

Required Work Experience (Brief description of the job-related experience needed to perform the job)
• Worked in a call center environment. – Call handling, transfers, inbound and outbound
• Understand call and email etiquette.
• Worked in a health insurance, medical or any related business.
• Exposed to administrative work like claims processing, billing etc.
• Experience with SAP or Salesforce is a plus

Required Qualifications (Brief description of the educational background needed to perform the job)
• This position does require someone who can obtain a Tier 1 background investigation for a position 
of trust after being offered a position and maintaining after starting with International SOS
(International SOS will facilitate) 
• Proficient at typing
• Proficient at basic computer applications (Microsoft Suite, Web browsing)
• Preferably educated to high school level or equivalent

Required Languages (Brief description of the language skills needed to perform the job)
• English language skills (oral and written)
• Ability to speak, read and write in Spanish preferred. 
• Bilingual in any other language is preferred

This job description outlines the types of responsibilities the incumbent is required to perform.The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.