Customer Service Representative

Summary: Under direction of the Supervisor, this position is responsible for fulfilling all duties and responsibilities necessary and associated with providing professional, accurate, and timely customer service to TriWest’s beneficiaries and providers. Respond to phone and web-mail inquiries regarding all aspects of the TRICARE program, to include information and assistance with enrollment, eligibility, benefits, and the location and use of network and certified providers. All tasks and responsibilities are to be performed in accordance with TRICARE policies and contract requirements.


Specific Duties and Responsibilities:
•Provide professional, accurate and timely responses to inquiries from providers and beneficiaries regarding the TRICARE programs, including information and assistance with enrollment, eligibility, benefits, referrals, authorizations, claims/collections, and the location and use of network and certified providers.
•Consistently display professional, friendly, and compassionate customer service skills.
•Coordinate complete resolution of service by engaging other departments including enrollment, claims health care services, and others as appropriate.
•Apply knowledge of all desktop applications, procedures and guidelines associated with the Customer Service Representative position.
•Respond to web-mail inquiries from beneficiaries and providers using clear and accurate written communication.
•Demonstrate a thorough understanding of the grievances and appeals process while assisting beneficiaries and providers.
•Accurately and thoroughly document all appropriate communications pertaining to beneficiary and provider contacts.
•Participate in all team, department and corporate meetings as required and/or assigned.
•Maintain and utilize effective relationships with other TriWest departments and team members.
•Continually expand knowledge in all aspects of the TRICARE program and technology.Job Requirements
Employment Standards:
•Excellent oral and written interpersonal communications skills including professional service etiquette.
•High level of initiative and self-motivation.
•High level of cooperation and willingness to function as part of a team.
•Flexibility to work any assigned shift within designated department hours of operation.
•Ability to learn and apply increasingly more complex concepts, policies, and procedures.
•Demonstrated flexibility, adaptability and problem solving skills.
•Proficient with computers and multiple software applications.
•Ability to prioritize and organize time and workload.
•Work well in a fast paced environment.
Education and Experience:
•High School diploma (or equivalent) with 1-2 years of administrative and/or medical experience preferred, or some college and a combination of education and equivalent background experience.
•Demonstrable customer service skills in a call center type of environment.
•Proficiency in Microsoft Word, data entry and typing skills in a Windows environment.

This position will require a Department of Defense (DoD) background check which includes completing the Standard Form 85P questionnaire and fingerprinting. DoD does NOT allow non-US citizens to begin work in this position prior to completion of the background checks, a process that can take several months. Tri West will NOT hold a position open during the pendency of the background checks.