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Claims Customer Support Representative (CSR)

Requisition Number:  31198

Trevose, PA, US

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Overall Purpose of the Role

To assist host nation providers and overseas beneficiaries on the TRICARE Benefit, and  claims submission processes and options, resolving and escalating claims issues when required.

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
•    Maintains confidentiality of all beneficiary information. Understand and carry out all policies and procedures pertaining to the duties of a Claims Customer Support Executive   
•    Answer all incoming calls using the prescribed protocols. Maintain all documentation in accordance with company policies and procedures.  Respond to in-bound inquiries promptly and ensure complete resolution.
•    Make outbound calls to follow up with beneficiaires and providers on claims queries, when appropriate 
•    Resolve claims issues on behalf of providers and beneficiaries, working with Intl.SOS teams and WPS to ensure timely and accurate resolution 
•    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 submission and payment solutions and other self-servicing products.
•    Maintain specific quality and quantity standards.
•    Adhere to company policies and procedures at all times, regardless of shift being worked. 
•    Assist with the training of new staff by mentoring them during their training program, when asked.
•    Comply within established service recovery protocol. 
•    Attends and participates in International SOS staff meetings and educational offerings

Required Work Experience and Qualifications

Required Work Experience (Brief description of the job-related experience needed to perform the job)
•    Experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
•    2-3 years customer service year experience desired 
•    Preferred processing health care claims and health insurance experience

Required Qualifications (Brief description of the educational background needed to perform the job)
•    High school diploma / GED (or higher) OR equivalent years of work experience
•    Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
•    Typing speed of 35 wpm minimum

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 . 

Other Requirements (Brief description of other requirements)
•    Able to work shift work (Days, Evening, Nights, weekends) on a rotational basis. 
•    Work Holidays, as needed 

•    Must be a US Citizen and able to obtain interim Tier 3/ Level II IT Security Clearance and maintain full Tier 3/ Level II IT Security Clearance (previously referred to as ADP II Clearance) upon offer acceptance

International SOS Government Services, Inc. require all prospective employees to be fully vaccinated against COVID- 19, where allowed by law.