Customer Service Representative
6 days ago
As a Customer Service Representative with Recruit Monitor, you will play a vital role in delivering exceptional customer experiences to our clients. We are seeking a highly skilled and motivated individual to join our team as a TRICARE Representative working remotely from home.
Our company is committed to making healthcare easier for those we serve, and we believe that this role is an excellent opportunity for someone who is passionate about providing top-notch customer service.
Responsibilities:- Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems.
- Apply appropriate provisions of TRICARE regulations, interpretations, and procedural directives in making determinations on eligibility and benefits to determine appropriate responses to inquiries.
- Obtain and analyze claims data to determine specific problem areas, including external communication to obtain data.
- Complete research and provide final resolution to inquiries within contractual requirements.
- Communicate with inquirers 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 inquirers 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.
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