A. Overall Purpose Of The Job
TRICARE Provider Support Services (TPSS): International SOS provides comprehensive healthcare management and related support services to beneficiaries enrolled in the TRICARE Overseas Program (TOP). The TPSS Team manages the provider relationships within the TRICARE Asia Pacific region and provides support to them in terms of education of the program and any claims or billing issues. Specifically the role will:
· Provide an efficient and effective claims and general customer service delivery to TOP providers and beneficiaries
· Be responsible for serving as a point of contact and educator for Host Nation Providers (HNP), on a proactive basis
· Interface with operational staff, TOP Regional Provider Network Management Services, TOP Network Claims and TOP NQC team members, and International SOS’ sub-contractor to facilitate the accurate and timely processing of claims
Undertake broader projects within the TOP Provider Network Management organization as assigned.
B. Key Responsibilities
· Respond to telephonic or written inquiries or complaints from HNP’s regarding their role as provider of medical and ancillary services for the TRICARE Military Treatment Facilities (MTF’s)
· Serve as a support to the In-Country team in their dealings with the HNPs.
· In response to queries from HNPs, provide information regarding status of payment for claims submitted. Deal with all aspects of invoice/claim, reimbursement and reconciliation of claims queries from clients, within a timely and professional manner. This will include receiving some invoices and claim forms from Providers, checking the required paperwork is in order and scanning these accurately to WPS for processing.
· Build expertise in claims submission and reimbursement (payment) matters.
· Communicate effectively and proactively as required with HNP’s, educating them on the claims submission process, and assisting providers in ensuring that claims will be properly submitted and accepted for processing and timely payment.
· Act professionally in all interactions with the service providers.
· Establish and maintain effective relationships with all internal and external stakeholder to ensure continuity of service delivery by providing general customer services to the Organization’s clients.
· Maintain accurate records including statistical information and client reports using the computer system(s) made available by the organization.
· Maintain confidentiality of all patients and/or client information.
· Involve the Medical Department for any medical irregularity on invoices and bring to the TPSS Manager’s attention, any cases where fraud is suspected.
· Ensure that the Manager is fully briefed on issues that may impact the delivery of the service providing Information as required
· Attend and participate in staff meetings, and internal and external educational offerings, as required.
C. Job Profile
Required Skills and Knowledge
· Customer Service Mindset
· Research and Analysis
· Excellent attention to detail
Required Competencies
· Planning and Organising: Sets clearly defined objectives; Plans activities and projects well in advance and takes account of possible changing circumstances; Manages time effectively; Identifies and organises resources needed to accomplish tasks; Monitors performance against deadlines and milestones.
· Following Instructions & Procedures: Appropriately follows instructions from others without unnecessarily challenging authority; Follows procedures and policies; Keeps to schedules; Arrives punctually for work and meetings; Demonstrates commitment to the organisation; Complies with legal obligations and safety requirements of the role.
· Learning and Researching: Rapidly learns new tasks and quickly commits information to memory; Gathering comprehensive information to support decision making; Demonstrates a rapid understanding of newly presented information; Encourages an organizational learning approach (i.e. learns from successes and failures and seeks staff and customer feedback); Manages knowledge (collects, catalogues, and disseminates knowledge of use to the organisation).
· Analysing: Analyses numerical data, verbal data and all other sources of information; Breaks information into component parts, patterns and relationships; Probes for further information or greater understanding of a problem; Makes rational judgements from the available information and analysis; Produces workable solutions to a range of problems; Demonstrates an understanding of how one issue may be a part of a much larger system.
· Adapting and Responding to Change: Adapts to changing circumstances; Accepts new ideas and change initiatives; Adapts interpersonal style to suit different people or situations; Deals with ambiguity, making positive use of the opportunities it presents.
· Deciding and Initiating Action: Makes prompt, clear decisions based on procedures; Takes responsibility for actions; Takes initiative, acts with confidence and works under own direction; Initiates and generates activity. Coping with Pressure & Setbacks
· Works productively in a pressurised environment; Keeps emotions under control during difficult situations; Balances the demands of a work life and a personal life; Maintains a positive outlook at work; Handles criticism well and learns from it
· Relating and Networking: Establishes good relationships with customers and staff; Builds wide and effective networks of contacts inside and outside the organisation; Relates well to people at all levels; Manages conflict;
· Delivering Results and Meeting Customer Expectations: Focuses on customer needs and satisfaction; Sets high standards for quality and quantity; Monitors and maintains quality and productivity; Works in a systematic, methodical and orderly way; Consistently achieves project goals.
Required Work Experience
· Experience of working within a customer service environment.
· Must have 2 years experience working in a contact centre or service delivery (operations) environment.
Required Qualifications
· Minimal GCE A Level education or equivalent.
· Successfully complete background checks and obtain security clearance.
Required Languages
· Excellent written and oral English Language skills to business standard.
