This position answers inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems. This job establishes and maintains rapport with contacts and present a favorable corporate image while responding to inquiries within time frames required to exceed contractual standards.
1707 West Broadway - Madison, WI 53713. Bus line accessible!
Schedule: Monday-Friday, full-time, 40 hours per week
Hours: 9:55am-7:00pm (other shifts may be available, pending seniority preference)
Starting Wage: $15.02/hour + $0.50 shift differential after 5:00pm
Employees are paid bi-weekly.
Employees are eligible for annual performance merit increases, prorated based on start date.
Pay for Performance, starting 2018!
Remote options available!
Start Date: Monday, January 22 2018
Available Benefits/Paid Time Off:
Medical (available from day 1 of employment!)
Health Saving/Flex Spending Accounts
401k (WPS will match up to 6% of employee contributions into a 401k account after just 30 days of employment)
5 days of PTO Regular (preplanned vacations/absences)
5 days of PTO OnDemand (sick time)
Characteristics and Responsibilities
- Receive telephone, written, fax, and e-mail inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing 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 area including external communication to obtain data.
- Complete research and provide final resolution to inquiries within contractual requirements.
- Communicate with inquirer 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 inquirer 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.
U.S. citizenship is required for this position due to U.S. Department of Defense restrictions.
- 2 or more years of experience in customer service
- Recent Military and Veterans Health claims processing with knowledge of TRICARE benefits and guidelines, system applications, medical terminology, and procedure codes
- High school diploma or equivalent
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities