Location: Remote FSLA Status: Non-exempt
Reports to: Program Manager EEO Category: Administrative Support Worker

JOB SUMMARY:Provides technical subject matter expert advisory services to the program leadership for both Community Care Network (CCN) and the TRICARE 5^th Generation Managed Care Support Contract and outstanding customer service related to Military and Veteran care. Primarily assigned as a consultant on requests from leadership on improving operational performance and quality of contact center encounters. May be assigned for coaching of CSRs, providing additional training of staff and other duties as required by the Program Manager. Based on direction from the Program Manager, may be assigned shifts for responding to inbound calls and chat messages regarding authorizations for medical and behavioral health care, provider status and availability, or claims payment and status. May also be assigned for outbound calls to schedule appointments based on direction from the Program Manager. Senior CSR is an expert in resolving administrative eligibility discrepancies through account research and review, accurately assessing caller requests and inquiries, and focusing on first-call resolution and/or appropriate call escalation protocols.

EDUCATION & EXPERIENCE 

Required

• Prior experience in customer service contact center supporting TRICARE beneficiaries
• Healthcare industry experience to include knowledge of health services
• High School diploma or GED
• One year experience in a customer service role with performance metrics
• Experience using Microsoft Office products and the Internet

Preferred

• Experience working on contact centers within the TRICARE East Region

KEY RESPONSIBILITIES 

• Consultant to the Program Manager and TriWest as a subject matter expert for contact center performance and quality supporting both VA CCN and T5. 
• Identified for additional coaching, training and other duties as assigned by the Program Manager to assist supervisors and CSRs in improving performance.
• Manages multiple tasks lists in accordance with directed timelines. Meets call volume, chat volume, schedule adherence, quality, Veteran appointment, and other production standards. 
• Initiates and receives phone calls, chat messages and emails from VA medical center staff, and providers to answer claims, eligibility, benefit, and program questions. In select markets, facilitates appointment scheduling of Veterans through outbound solicitation to providers. Records preferences tracks Veteran questions thoroughly in the TriWest’s Customer Relationship Management systems and Portal, as well as VA’s HSRM systems. 
• Consistently displays professional and courteous service skills to internal and external customers. 
• Accurately resolves VA and provider inquiries with a focus on first call resolution. 
• Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI).
• Takes appropriate measures to comply with HIPAA regulations to protect privacy of customers' health information. 
• Documents all communications involving Veteran and provider contacts. Uses critical thinking in problem solving and follows established processes to assure quality program compliance. 
• Consistently meets department productivity and performance metrics to include regular and consistent attendance.
• Participates in cross training, employee development and flexible assignments to ensure business needs are met.
• Review proposed user stories for CRM
• Assist with content writing, and quality assurance criteria
• Assist with other customer-facing areas (e.g., portal) on proposed content.

COMPETENCIES

Technical Skills 

A subject matter expert in contact center operations and the TRICARE benefit

Proficient data entry skills: Ability to meet daily call and chat requirements.

Team Building / Team Player 

Influence the actions and opinions of others in a positive direction and build group commitment.

Organizational Skills 

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Information Management

Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

High Intensity Environment

Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Empathy / Customer Service

Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Coping / Flexibility

Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Computer Literacy

Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Communication / People Skills

Ability to shape ideas and concepts into actions for improvement of operations and quality of service

Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Commitment to Task

Ability to conform to established policies and procedures; exhibit high motivation.

WORKING CONDITIONS 

• Ability to cover any work shift
• Ability to work overtime, if needed
• Works within a standard office environment, with no travel
• Extensive computer work with prolonged sitting and wearing of headset

** This job description indicates the general nature and levels of work expected of the incumbents. It is not designed to cover or contain a comprehensive listing of activities, duties, responsibilities, or competencies required of an incumbent. Incumbents may be asked to perform other duties as required. **