TRICARE Customer Service Executive

Essential Job Duties and Responsibilities:

At International SOS, we are in the business of protecting and saving lives. For 40 years, we have delivered customised security risk management, health, and wellbeing solutions to organisations worldwide. With a presence in 90 countries and a team of nearly 13,000 experts, we provide 24/7 support to help organisations fulfil their Duty of Care responsibilities.

Now, we’re looking for talented individuals to join our team and make a difference.

The Customer Service Executive serves as the first point of contact for beneficiaries, providers, and stakeholders seeking assistance with the TRICARE Overseas Program (TOP).

This role delivers operational support across multiple service areas, including claims inquiries, enrollments, and general program information. The position responds to inbound and outbound calls and electronic communications from current and former US military members, their families, and medical providers globally, ensuring timely, accurate, and empathetic assistance aligned with program guidelines and customer service standards.

Key Responsibilities: 

• Respond to inbound calls and electronic contacts promptly using established protocols, ensuring issues are fully resolved or appropriately referred.
• Provide operational support and guidance to beneficiaries and providers regarding claims processing, enrollments, program benefits, and TRICARE rules.
• Resolve problem cases independently or by collaborating with International SOS regional teams, in-country resources, government points of contact, and claims processors (WPS).
• Make outbound calls to beneficiaries and providers to follow up on claims, enrollments, or service inquiries.
• Respond to assigned cases within the Customer Relationship Management (CRM) system, ensuring timely and thorough resolution in accordance with established protocols.
• Actively promote and educate customers on self-service options, including electronic claims submission and payment solutions.
• Maintain confidentiality of beneficiary and provider information in accordance with HIPAA and organizational policies.
• Ensure adherence to quality, quantity, and compliance standards in all interactions.
• Support the onboarding and training of new team members through mentoring and knowledge sharing as requested.
• Comply with established service recovery protocols, escalating issues when necessary.
• Participate in staff meetings, training sessions, and continuous education opportunities.
• Perform additional duties as assigned by leadership.

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

• Identifies and acts on potential problems and/or challenges
• Demonstrates effective problem-solving skills and lateral thinking
• Ability to work under pressure, multi-task and prioritize in a timely and effective manner
• Drives for results
• Ability to learn quickly and adapt to a fast-paced environment
• Proficient in MS Suite (Outlook, Word, Excel) and Web browsing
• Ability to provide clear and concise written updates in English
• Ability to write, speak and listen effectively in English required, Spanish and/or Portuguese a plus

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

• Delivering Results & Meeting Customer Expectation 
  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 so that others can understand. Promptly informs others when needing guidance with assigned tasks.

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, enrollments, billing etc.
• Experience with SAP or Salesforce is a plus
• Or equivalent military experience

Required Qualifications (Brief description of the educational background needed to perform the job)

• Must be able to work a shift-based position with fixed schedules 
• This position does require someone who can obtain and maintain the appropriate level of tiered investigation access for a position of Trust after being offered a position. International SOS will facilitate.
• Proficient at typing
• Proficient at basic computer applications (MS Suite, Web browsing)
• Preferably educated to High School level or equivalent 
• College Graduate Preferred

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