TRICARE Service Representative

Job Summary: Under supervision, provides assistance to walk-in customers and answers beneficiary-related questions regarding all aspects of the TRICARE program, to include information and assistance with eligibility and the enrollment process; the location and use of network providers; the value and benefits of using the MTF; claims research; information about the grievance and appeals process; and making appropriate entries regarding customer inquiries and assistance provided in the West Region Desktop Application (WRDA).

 

Key Responsibility Areas:

· Provides individualized, compassionate, and single-visit resolution of customer service encounters for walk-in beneficiaries and MTF staff regarding TRICARE eligibility & benefits, enrollment, referrals, authorizations, access to care, claims, and other assistance as required

· Understands the grievance and appeals process and assists beneficiaries as necessary

· Maintains effective relationships with MTF staff, representatives of local civilian providers, and staff from the Hub and Corporate offices which support the TSC

· Uses the WRDA procedural guide in performing assigned duties including documenting all beneficiary contacts

· Receives and accounts for enrollment premium payments

· Performs other duties as assigned

 

Working Conditions:

Favorable working conditions in a climate controlled office space; Must be available for to cover any work shift; Works within an office environment with minimal travel required; level II IT security clearance.

 

Employment Standards:

· Excellent customer service, interpersonal and communication skills

· Ability to understand and work with computers to include the use of various software programs

· Ability to learn and understand the TRICARE program, its benefits and services, and effectively explain them to beneficiaries, provider representatives, and others as needed

 

Education and Experience:

· High School Diploma or G.E.D. equivalent

· Prior experience with provision of customer services in a healthcare setting is preferred

· Recent experience with TRICARE and the Military Health System is preferred