About the role
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.
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.
About you
- Minimal GCE A Level education or equivalent.
- Successfully complete background checks and obtain security clearance.
- Experience of working within a customer service environment.
- Must have 2 years experience working in a contact centre or service delivery (operations) environment.
- Excellent written and oral English Language skills to business standard.
- Other languages beneficial, in particular Korean or Tagalog
- Customer Service Mindset
- Research and Analysis
- Excellent attention to detail
