Customer Service Representative

Customer Care Specialist answers inquiries from providers and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems. This position establishes and maintains rapport with contacts and present a favorable corporate image while responding to inquiries within time frames required to exceed contractual standards. 

Characteristics and Responsibilities The CSR's will be exclusively handling provider calls These calls will revolve around the status of claims, submitting claims, or following up on rejected claims. Obtain and analyze claims data to determine specific problem area including external communication to obtain data. Complete research and provide final resolution to inquiries within contractual requirements. Communicate with inquirer to determine appropriate authorization or referral of services. Submit claims for adjudication, correction, payment, or review as appropriate. Educate providers on billing requirements of TRICARE to reduce claim problems. Deal tactfully with people in a wide variety of situations to convey a favorable corporate image. Respond to inquirer using various forms of communication (written letter, telephone, web, or email) within time frames to exceed contractual standards. Collect and record data for Customer Service records and computer analysis. Inform supervisory staff of system problems when identified, researching problems to provide backup data and examples when needed. They will be handling mostly phone communication with providers but in dowtime they will perform written correspondences from Tricare Providers

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