Claims Customer Support Representative

Essential Job Duties and Responsibilities:

Overall Purpose of the Role

The Claims Customer Support Representative would be 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.

Job Profile

Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)

• Empathic speaking skills
• Ability to use positive language
• Good understanding of process and claims submission options
• Good understanding of challenges and needs regarding TRICARE benefit

Required Competencies (Critical behaviours necessary to successfully perform the job)

• Delivering Results & Meeting Customer Expectations: Focuses on listening to and understanding the customer needs; seeks ways to resolve their specific questions; sets high standards for both quality and quantity; works in a systematic, methodical and organized way; owning issues until they are fully resolved to the customers need.
• Following Instructions & Procedures: Follows procedures and policies; keeps to schedule; is punctual for work and meetings and is reliable; demonstrates commitment to the organization; complies with legal obligations and safety requirements for the role.
• Coping with Pressures & Setbacks: Works productively in a pressurized environment; emotionally resilient during difficult situations; balances the demands of a work life and a personal life; maintains a positive and healthy outlook at work; uses feedback to learn.
• Working with People: Demonstrates an interest in and understanding of other people; adapts to the team and builds team spirit; recognizes and rewards the contribution of others; listens, consults others and communicates proactively; supports and cares for others;
• Communicating Effectively: Communicates in a clear and organized manner verbally and in writing, so that others can understand. Promptly informs others when needing guidance with assigned tasks.
• Problem solving/Analyzing:Analyses data and all other sources of information; Breaks information into component parts, patterns and relationships; Probes for further information or greater understanding of a problem; Makes rational judgements from the available information; Produces workable solutions to a range of problems; Demonstrates an understanding of how one issue may be a part of a much larger system.

Required Qualifications

Required Work Experience (Brief description of the job-related experience needed to perform the job)

• Customer Service Experience in person or on the phone.
• Preferred – Being familiar with the claims process.

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.
• 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

Other Requirements (Brief description of other requirements)

• Rotational Shift requirements