REMOTE Call Center Customer Service Representative (Managed Care Provider, Claims, Inbound and Outbound)

TriWest Healthcare Alliance

Date: 1 week ago
City: Washington, DC
Contract type: Full time
TriWest Healthcare Alliance

In order to apply you must reside in one of the following States: AK, AZ, CO, VA, HI, ID, NM, NV, OR, TX, UT, W

Provides outstanding customer service related to Veteran care through the Community Care Network (CCN) in a fast-paced contact center. Responds to inbound calls and chat messages regarding authorizations for medical and behavioral health care, provider status and availability, or claims payment and status. Accurately assesses caller requests, answers caller inquires and processes requests while focusing on first call resolution and/or appropriate call escalation protocols. May makeoutbound calls to schedule appointments based on Veteran or VA request. Resolves administrative eligibility discrepancies through account research and review.

**Prefer Veteran and Military Families**

Education & Experience


o High School diploma or GED o One year experience in a customer service role with performance metrics o Experience using Microsoft Office products and the Internet


o Healthcare industry experience to include knowledge of health services o Contact center experience to include call center chat messaging o Military experience focusing on service delivery

Key Responsibilities

o Manages multiple tasks lists in accordance with directed timelines. Meets call volume, chat volume, schedule adherence, quality, Veteran appointment and other production standards. o Initiates and receives phone calls, chat messages and emails from VA medical center staff, and providers to answer claims, eligibility, benefit and program questions. In select markets, facilitates appointment scheduling of Veterans through outbound solicitation to providers. Records preferences, tracks Veteran questions thoroughly in the TriWest’s Customer Relationship Management systems and Portal, as well as VA’s HSRM systems. o Consistently displays professional and courteous service skills to internal and external customers. o Accurately resolves VA and provider inquiries with a focus on first call resolution. o Protects the privacy of health information of patients when using or disclosing Protected Health Information (PHI). o Takes appropriate measures to comply with HIPAA regulations to protect privacy of customers' health information. o Documents all communications involving Veteran and provider contacts. Uses critical thinking in problem solving and follows established processes to assure quality program compliance.

o Consistently meets department productivity and performance metrics to include regular and consistent attendance. o Participates in cross training, employee development and flexible assignments to ensure business needs are met.


Commitment to Task:
Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills:
Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Proficient data entry skills; Ability to meet daily call and chat requirements.

Company Overview

Company Overview

Taking Care of Our Nation’s Veterans.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We are On a Mission to Serve!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance we have proudly been on that important mission since 1996.



More About Working at TriWest Healthcare Alliance

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Team members work from home or in one of our state-of-the-art facilities. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

  • Medical, dental and vision coverage

  • Generous paid time off

  • 401(k) Retirement Savings Plan (with matching)

  • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance

Equal Employment Opportunity

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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