Experienced Customer Service Representative for TRICARE and Medicare Benefits – Call Center Support and Claims Resolution Expert

Introduction to blithequark At blithequark, we are dedicated to providing exceptional customer service to military members, retirees, and their dependents who are eligible for TRICARE and Medicare benefits. As a leading health solutions company, we have been making healthcare easier for the people we serve for nearly 80 years. Our mission is to deliver high-quality services that exceed our customers' expectations, and we are seeking a talented Customer Service Representative to join our team in Madison, WI. Job Overview We are looking for a skilled and compassionate Customer Service Representative to provide call center support and resolve claims and billing inquiries from hospitals and clinics. The successful candidate will play a critical role in navigating multiple systems to research and resolve complex inquiries with clear, accurate, and easy-to-understand responses. This is a Bargaining Unit/Union position that offers a competitive salary, excellent benefits, and opportunities for career growth and development. Key Responsibilities Receive and respond to telephone, written, fax, and email inquiries concerning TRICARE eligibility, benefits determinations, and claims adjudication questions or billing problems. Apply appropriate provisions of TRICARE regulations, interpretations, and procedural directives to make determinations on eligibility and benefits. Obtain and analyze claims data to determine specific problem areas, including external communication to obtain data. Complete research and provide final resolution to inquiries within contractual requirements. Communicate with inquirers 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 inquirers 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. Essential Qualifications U.S. citizenship is required for this position due to Department of Defense restrictions. Must live within the vicinity of our Madison, WI campus location (45 Miles from 1717 W. Broadway Madison, WI). High school diploma or equivalent. 2 or more years of experience in customer service (Call Center). Ability to learn medical and insurance terminology. Preferred Qualifications Expertise in Microsoft Office (Outlook, Word, Excel), internet, intranet, office equipment, and data entry. Ability to navigate dual monitor screens and between multiple programs at once. Strong skillsets in multi-tasking, research, and problem-solving. Ability to work independently, deescalate situations with agitated individuals, control difficult situations, as well as influence and motivate others to comply with TRICARE procedures. Career Growth and Development Opportunities At blithequark, we are committed to the growth and development of our employees. As a Customer Service Representative, you will have the opportunity to develop your skills and knowledge in a dynamic and supportive environment. Our training programs are designed to help you succeed in your role and advance your career. You will also have access to professional and leadership development programs, performance bonus and/or merit increase opportunities, and a competitive 401(k) plan with a dollar-per-dollar match up to 6% of salary. Work Environment and Company Culture Our culture is built on the principles of open communication, empowerment, and recognition. We believe in creating an environment where our employees can thrive and grow, both personally and professionally. At blithequark, you will be part of a fun, supportive team that offers great advancement opportunities throughout the organization. We are proud of our recognition as a military and veteran-ready employer and are committed to making a positive impact in the lives of our customers and employees. Compensation, Perks, and Benefits We offer a competitive salary of $17.75/hour, plus a 2nd shift differential of $0.75/hour. Our benefits package includes remote and hybrid work options, performance bonus and/or merit increase opportunities, 401(k) with a dollar-per-dollar match up to 6% of salary, competitive paid time off, health insurance, dental insurance, and telehealth services starting on day one. We also offer professional and leadership development programs to help you grow and advance in your career. Conclusion If you are a motivated and compassionate individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity. As a Customer Service Representative at blithequark, you will be part of a dynamic team that is dedicated to making a positive impact in the lives of our customers. Don't miss out on this chance to join our team and start your career with a leading health solutions company. Apply now and take the first step towards a rewarding and challenging career with blithequark. Apply for this job