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Location: Remote                                       

FSLA Status: Non-exempt

Reports to: TRICARE Supervisor            

EEO Category: Administrative Support Worker

JOB SUMMARY:
Provides technical subject matter expert advisory services to staff supporting the TRICARE 5^th Generation Managed Care Support contract (T5) with outstanding customer service related to Military Service Member care. Based on direction from the Operations 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 based on direction from the Operations Manager. This Subject Matter Expert (SME) is a specialist in resolving eligibility discrepancies through account research and review, accurately assessing caller requests and inquiries, and focusing on first-call resolution and/or handling escalated callers. 

EDUCATION & EXPERIENCE 

Required

• At least two years of professional work experience in a customer service environment
• Healthcare industry experience to include knowledge of health services
• High School diploma or GED
• Experience using Microsoft Office products and the Internet

Preferred

• Experience supporting TRICARE beneficiaries through a contact center environment. 
• At least one year of experience handling escalated calls

KEY RESPONSIBILITIES 

• Provides phone and/or chat support to CSRs by answering question and providing guidance to find resources to assist their callers
• Handle escalated calls
• Manages multiple tasks in accordance with directed timelines. 
• Consistently displays professional and courteous service skills to internal and external customers. 
• Accurately resolves DoD 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 TRICARE beneficiaries 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.

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 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. **