Job Details

About the job Customer Service Representative (Remote)

Paychex Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are guided by our Purpose: Together, making health care easier for the people we serve.

Role Snapshot

Answer inquiries from beneficiaries, providers, and other affiliated representatives or groups regarding TRICARE eligibility, benefit determinations, and claims adjudication questions or problems.

In This Role You Will

• 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.

• Enjoy working in a high-volume call center
• Excel at providing timely, accurate answers via telephone by employing strong listening skills
• Enjoy new challenges and approach each day with a positive attitude
• Demonstrate a strong work ethic with a history of dependability and respect
• Possess excellent information retention capabilities
• Thrive in an environment that offers opportunities for continuous learning

• Gaining experience working in a call center environment
• Having the ability to work remotely from home
• Building in-depth communication and customer service skills
• Being a part of a fun, supportive team that offers great advancement opportunities throughout the organization
• Working in an environment that serves our Nations military, veterans, Guard and Reserves along with their families

• U.S. citizenship is required for this position due to Department of Defense restrictions
• High school diploma or equivalent

• 2 or more years of experience in customer service
• Ability to learn medical and insurance terminology
• Microsoft Office Experience
• Ability to navigate dual monitor screens and between multiple programs at once
• Strong skillsets in multi-tasking, research, and problem-solving