Enrollment Specialist - Fees

Overview

This role supports beneficiaries by performing complex account administration and billing reconciliation for TRICARE Prime and TRICARE Reserve Select programs. It requires advanced knowledge of DEERS Catastrophic Cap and Deductible and PGBA TMBS systems, analyzing and applying business rules for different beneficiary categories in a complex fee-structured environment. The position also determines the impact of certain Qualifying Life Events on enrollment and billing structures.

This is a remote position available only to candidates located in AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI, and WY.

The role requires U.S. citizenship and the ability to obtain a favorable interim and final Department of Defense background investigation.

Veterans, Reservists, Guardsmen, and military family members are encouraged to apply.

Responsibilities

• Research beneficiary account billing records to reconstruct payment history and verify accurate fee statements are sent to the correct beneficiary address using Defense Online Enrollment System, PGBA TMBS system, and Catastrophic Cap and Deductible System.
• Validate that payments are posted and applied accurately, including correct paid-through dates, fee schedules, bill types, and enrollment eligibility dates for each fiscal billing cycle period.
• Respond to inquiries from call centers, customer service requests, military treatment facilities, and beneficiaries to ensure timely and accurate billing statements.
• Ensure correct posting of payments, application of quarterly fees, and resolution of overpayments or discrepancies.
• Assist other departments in obtaining proof of payment for reported fee discrepancies.
• Modify billing information in PGBA TMBS and Defense Online Enrollment systems to reflect beneficiary status changes and ensure appropriate fund distribution and system updates.
• Reconcile beneficiary accounts using available reports and troubleshoot allotment/EFT payments and recurring credit card processes.
• Update fee schedules and adjustments as needed and investigate fee discrepancies to resolution.
• Process split enrollments and coordinate allotment changes with accounting and other TRICARE contractors.
• Participate in cross-functional subcontractor and government sessions to improve billing processes.
• Process reinstatements for beneficiaries disenrolled in error and ensure previous claim payments are re-adjudicated.
• Complete fee exception reports on enrollment and related fee errors or warnings.
• Investigate and prepare refund requests.
• Notify beneficiaries when insufficient fee payments are identified.
• Perform other duties as assigned.

Requirements

• Bachelor's degree in Accounting, Healthcare Administration, or related business field, or equivalent experience.
• U.S. citizenship.
• Ability to obtain a favorable interim and final Department of Defense background investigation.
• Experience in healthcare billing, accounts receivable, auditing, or other accounting-related disciplines.
• Thorough knowledge of accounts receivable and accounting principles.

Preferred Qualifications

• Knowledge and experience with TRICARE payment processing.

Competencies

• Commitment to task with adherence to policies and high motivation.
• Strong communication and interpersonal skills, including the ability to influence, adapt, listen critically, and collaborate.
• Proficiency in Microsoft Office and department-specific software applications.
• Resiliency and flexibility in adapting to various situations and individuals.
• Customer service orientation with empathy, patience, and respect.
• Independent thinking and self-initiative to achieve outcomes without direction.
• Ability to manage complex information and communicate clearly.
• Effective multi-tasking and time management in a high-volume, high-stress environment.
• Strong organizational skills with attention to detail.
• Problem-solving and analytical skills with sound judgment.
• Thorough understanding of TRICARE policies and contract requirements related to enrollment.
• Strong data entry skills.

Working Conditions

• Work within a standard office environment or approved remote setup.
• Availability to cover any work shift.
• Ability to maintain production standards in a repetitive work environment.

Compensation & Benefits

• Salary range generally between $42,000 and $44,000 per year, varying by role and location.
• Medical, dental, and vision coverage.
• Paid time off.
• 401(k) retirement savings plan with matching.
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance.
• Tuition reimbursement.
• Paid volunteer time.

Equal Employment Opportunity

The employer is an equal opportunity employer committed to creating an inclusive environment that supports diversity at every organizational level. Candidates from all backgrounds are encouraged to apply. Employment decisions are made without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected status under applicable laws.